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DUPLICATE 


HXOOO 12882 

IS  LEPRUSY  INCREASING? 


By 

FREDERICK  L.  HOFFMAN,  LL.  D.,  F.  S.  S.,  F.  A.  S.  A. 

Third  Vice  President  and  Statistician,  The  Prudential  Insurance  Company 

of  America,  Associate  Fellow  American  Medical  Association, 

Member  Royal  Sanitary  Institute,  Member  American 

Public  Health  Association,  etc.,  etc. 


AN  ADDRESS 

Delivered  at  a  meeting  of  the  American  Medical  Association 
New  Orleans,  La.,  April  26,  1920 


SCIENTIFIC  PUBLICATIONS 


STATISTICIAN'S  DEPARTMENT 

THE  PRUDENTIAL  INSURANCE  COMPANY  OF  AMERICA 

HOME  OFFICE,  NEWARK,  NEW  JERSEY 


(AVAILABLE  ON  REQUEST) 

INDUSTRIAL  HYGIENE 
Industrial  Accidents  and  Their  Relative  Frequency  in  Different  Occupations  (1914). 
The  Mortality  from  Diseases  of  the  Lungs  in  American  Industry  (1916). 
Some  Theoretical  and  Practical  Aspects  of  Industrial  Medicine  (1917). 
Mortality  from  Respiratory  Diseases  in  Dusty  Trades — Inorganic  Dusts  (1918). 
Menace  of  Dust,  Gases  and  Fumes  in  Modern  Industry  (1918). 

HEALTH  INSURANCE 
Facts  and  Fallacies  of  Comptdsory  Health  Insurance  (1917). 
Public  Health  Progress  Under  Social  Insurance  (1917). 
Autocracy  and  PaternaUsm  versus  Democracy  and  Liberty  (1918). 
Failure  of  German  Compulsory  Health  Insurance:  A  War  Revelation  (1918). 
Health  Insurance  and  the  Public  (1919). 

More  Facts  and  Fallacies  of  Compulsory  Health  Insurance  (1919). 
National  Health  Insiurance  in  Great  Britain  (1920).  * 

CANCER 

Educational  Value  of  Cancer  Statistics  (1914). 
Accuracy  of  American  Cancer  Mortality  Statistics  (1914). 
The  Mortality  from  Cancer  Throughout  the  World  (1915). 
Cancer  from  the  Statistical  Standpoint  (1916). 

MALARIA 
A  Plea  and  a  Plan  for  the  Eradication  of  Malaria  in  the  Western  Hemisphere  (1916). 
The  Malaria  Problem  in  Peace  and  War  (1918). 

MISCELLANEOUS 

Rural  Health  and  Welfare  (1912). 

Uniformity  of  Annual  Reports  of  Local  Boards  of  Health  (1913). 

The  Chances  of  Death  and  The  Ministry  of  Health  (1913). 

The  Economic  Progress  of  the  United  States  During  the  Last  Seventy-five  Years(  1914) 

American  Public  Health  Problems  (1915). 

Leprosy  as  a  National  and  International  Problem  (1916). 

The  Sanitary  Progress  and  Vital  Statistics  of  Hawaii  (1916). 

On  the  Physical  Care  of  Children  (1916). 

The  Tuberculosis  Death  Rate  in  1916  (1917). 

Army  Anthropometry  and  Medical  Rejection  Statistics  (1917). 

The  Mortahty  from  Degenerative  Diseases  (1918). 

A  Plan  for  a  More  Effective  Federal  and  State  Health  Administration  (1919). 

Pauper  Burials  and  the  Interment  of  the  Dead  in  Large  Cities  (1919). 

Some  Statistics  of  Influenza  (1919). 

Is  Leprosy  Increasing  (1920)? 

CHARTS 

Typical  Causes  of  Death  Infant  Mortality  Typhoid  Fever 

Cancer  Infantile  Paralysis  Accidents 

Influenza  Diphtheria  Mortality  of  the  United  States 

Leprosy  Measles  and  Germany 

Malaria  Scarlet  Fever  Pauper  Burials 

Tuberculosis  Whooping  Cough  Army  Anthropometry 


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IS  LEPROSY  INCREASING? 


FREDERICK  L.  HOFFMAN,  LL.  D.,  F.  S.  S.,  F.  A.  S.  A. 

Third  Vice  President  and  Statistician,  The  Prudential  Insurance  Company 

of  America,  Associate  Fellow  American   Medical  Association, 

Member  Royal  Sanitary  Institute,  Member  American 

Public  Health  Association,  etc.,  etc. 


AN  ADDRESS 

Delivered  at  a  meeting  of  the  American  Medical  Association 
New  Orleans,  La.,  April  26,  1920 


1920 

PHUDENTIAL  PRESS 

NEWARK,  N.  J. 

U.  S.  A. 


Foreign  Agents 

Messhs.  p.  S.  king  &  SON,  LTD. 

2  AND  4  GREAT  SMITH  ST. 

LONDON,  ENG. 


CONTENTS 

Page 

The  Extent  of  Leprosy  in  the  United  States 5 

Estimate  by  Dr.  Isadore  Dyer 5 

Estimate  by  Dr.  Howard  Fox 5 

Estimate  by  Dr.  Martin  F.  Engman 6 

The  United  States  Senate  Committee  Inquiry 6 

The  Literature  of  Leprosy 6 

Modern  Views  on  Segregation 7 

Leprosy  in  Louisiana 8 

Leprosy  Admissions,  by  Race,  Sex,  and  Average  Age 10 

Varieties  of  Leprosy  in  Louisiana 10 

The  Fatality  Rate  in  Leprosy 11 

Discharges  and  Cures 12 

Absconding  Cases 12 

Deportations 13 

Leprosy  in  the  Young 13 

Treatment  and  Cure 14 

Leprosy  in  California 14 

Leprosy  in  Massachusetts 14 

Leprosy  in  the  United  States  Registration  Area 14 

Revised  Estimate  of  Leprosy  Cases  in  the  United  States 15 

Urgent  Need  for  a  Federal  Leprosarimn 16 

Leprosy  in  Canada _. 16 

Leprosy  in  Cuba 16 

Leprosy  in  Porto  Rico 17 

Leprosy  in  Panama  Canal  Zone 17 

Leprosy  in  Rio  de  Janeiro 18 

Leprosy  in  Sao  Paulo 18 

Leprosy  in  Brazil 18 

Leprosy  in  Argentine  Republic 19 

Leprosy  in  Venezuela 19 

Leprosy  in  Barbados 19 

National  Conference  on  Leprosy  in  Argentina 20 

Geographical  Distribution  in  Brazil 20 

Urgency  of  a  Broader  National  Interest 20 

Recent  Cases  of  Leprosy  Throughout  the  United  States,  1916-1920 21 

Urgency  of  a  More  Qualified  Professional  Interest 21 

Cases  of  Leprosy  in  the  United  States  Reported  Since  1916 22-27 

Need  and  Value  of  a  National  Leprosy  Conference 27 

Medical  and  Dermatological  Aspects  of  Leprosy 28 

Present  Status  of  the  Federal  Leprosarium 30 

Importance  of  Accurate  and  Complete  Leprosy  Statistics 31 

Summary  of  Conclusions 32-34 


CONTENTS  (Continued) 

Page 

Appendix  A — Leprosy  in  India 35-40 

Appendix  B — Leprosy  Statistics : 

Leprosy  Admissions — Louisiana  Leper  Home 41 

Leprosy  Admissions  by  Age  and  Sex 41 

Leprosy  Admissions — San  Francisco,  Calif 42 

Leprosy  Admissions — Massachusetts 42 

Leprosy  Deaths — United  States  Registration  Area 43 

Leprosy  Deaths  by  States 43 

Leprosy  Mortality  in  Cuba 44 

LeprosyCases  in  Cuba 44 

Leprosy  in  Porto  Rico 44 

Leprosy  in  Panama  Canal  Zone 45 

Leprosy  in  City  of  Rio  de  Janeiro 46 

Leprosy  in  Sao  Paulo 46 

Leprosy  in  Federal  District  of  Rio  de  Janeiro 47 

Leprosy  in  Pernambuco 47 

Leprosy  in  Venezuela 48 

Leprosy  in  Barbados 48 

Leprosy  in  India 49 

Leprosy  Statistics — Hawaii 49-51 

Leprosy  in  Union  of  South  Africa 51 

Leprosy  in  United  States,  1920 — by  States 52-53 

CHARTS 

Leprosy  in  the  United  States , Frontispiece 

Leprosy  in  Louisiana 9 

Leprosy  in  Hawaii 29 


IS  LEPROSY  INCREASING! 

The  Extent  of  Leprosy  in  the  United  States 
The  question  as  to  whether  leprosy  is  on  the  increase  in  this  country 
is  one  of  considerable  medical,  general  scientific,  and  humanitarian  inter- 
est. The  question,  unfortunately,  can  not  be  answered  in  a  satisfactory 
manner  by  an  appeal  to  thoroughly  trustworthy  statistics,  for  neither  the 
Federal  Government  nor  any  one  of  the  several  States  has  undertaken  an 
investigation  commensurate  with  all  that  is  involved  in  whatever  answer 
may  be  forthcoming.  At  best  only  an  approximate  guess  can  be  advanced 
as  to  the  probable  number  of  lepers  in  the  United  States  at  the  present 
time,  but  it  is  safe  to  assume  that  the  actual  number  is  less  than  the  earlier 
estimates  would  seem  to  justify.  An  attempt  to  answer  the  question  by 
an  appeal  to  statistical  evidence  was  made  at  the  time  when  the  Senate 
Committee  on  Public  Health  and  National  Quarantine  considered  the 
establishment  of  a  national  leprosarium  for  the  care  of  leprosy  cases, 
chiefly  of  an  international  or  interstate  character.  The  results  of  several 
inquiries  made  of  State  and  local  boards  of  health  throughout  the  country 
seem  to  indicate  that  there  are  probably  not  far  from  two  hundred  and 
fifty  officially  known  cases  of  leprosy  in  the  United  States,  and  possibly 
as  many  as  five  hundred  cases  known  and  suspected.  The  United  States 
Public  Health  Service  has  given  publicity  to  similar  inquiries  but  they 
have  never  been  inclusive  of  all  the  States  and  the  localities  not  required 
to  report  to  some  central  authority.* 

Estimate  by  Dr.  Isadore  Dyer 
Dr.  Isadore  Dyer,  of  New  Orleans,  probably  the  foremost  leprologist 
in  the  United  States,  in  his  evidence  before  the  Senate  Committee  on  Pub- 
lic Health  and  National  Quarantine,  on  March  26,  1916,  referred  to  an 
estimate,  according  to  which  the  number  of  cases  of  leprosy  in  the  United 
States  was  four  hundred,  of  which  probably  three  hundred  and  fifteen  were 
cases  in  the  State  of  Louisiana.  This,  however,  was  a  statement  based 
upon  inquiries  made  some  years  earlier,  and  Dr.  Dyer  in  his  evidence 
presented  a  revised  estimate,  according  to  which  he  placed  the  number 
of  lepers  throughout  the  United  States  in  1916  at  from  800  to  1,200, 
basing  his  conclusions  upon  the  observed  experience  and  apparent  rate  of 
increase  in  the  State  of  Louisiana. 

Estimate  by  Dr.  Howard  Fox 
Dr.  Howard  Fox,  of  New  York,  Clinical  Professor  of  Dermatology, 
also  a  recognized  authority  on   leprosy,  placed  a  statement  before  the 
same  committee,  according  to  which  the  number  of  leprosy  cases  in  the 

♦In  1907  the  United  States  Public  Health  Service  traced  139  cases  of  leprosy  in  the  continental 
United  States.  In  1912  the  nnmber  so  ascertained  was  146.  In  1920,  according  to  my  own  inquiry,  there 
are  242  cases.   (See  table  XXIV,  Appendix  B.) 


United  States  was  estimated  at  from  500  to  1,000.  Dr.  Fox,  however, 
apparently  had  based  his  estimates  largely  upon  his  experience  in  the 
city  of  New  York,  where  some  thirty  cases  had  come  mider  his  personal 
observation.  According  to  his  estimate  the  nmnber  of  cases  of  leprosy  in 
the  city  of  New  York  at  that  time  was  fifty. 

Estimate  by  Dr.  Martin  F.  Engman 
Dr.  Martin  F.  Engman,  Professor  of  Skin  Diseases,  Washington  Uni- 
versity, St.  Louis,  testified  that,  in  his  judgment,  an  estimate  of  800 
leprosy  cases  in  the  United  States  was  entirely  too  low,  and  he  went  so 
far  as  to  intimate  that  the  probable  number  was  three  times  as  large.  In 
support  ofi  his  statement  he  directed  attention  to  a  return  of  the  United 
States  Public  Health  Service  for  the  year  1911,  according  to  which  there 
was  only  one  case  of  leprosy  m  Missouri,  when,  to  his  personal  knowl- 
edge, there  were  certainly  at  the  time  three  cases  in  St.  Louis  alone.  He, 
however,  was  frank  to  say  that  it  was  impossible  "to  estimate  the  nmnber 
of  cases  of  leprosy  in  this  coimtry  with  any  accuracy  at  all." 

The  United  States  Senate  Committee  Inquiry 
It  would  serve  no  practical  purpose  to  enlarge  upon  the  various  esti- 
mates presented,  since  in  not  a  single  case  has  the  evidence  been  forth- 
coming that  a  really  thoroughgoing  effort  had  been  made  to  ascertain  the 
facts.  It  was  my  privilege  at  about  that  time  to  present  to  the  Senate  Com- 
mittee a  first  effort  to  assemble  the  leprosy  statistics  of  foreign  countries 
making  at  least  fairly  trustworthy  returns,  and  a  mass  of  material  was 
printed  in  the  report  of  the  committee,  which  is  still  available  to  those 
who  may  wish  to  pursue  the  subject  further.  (Senate  Report  306,  64th 
Congress,  1st  session,  Washington,  1916.) 

The  Literature  of  Leprosy 

In  continuation  of  the  earlier  investigation  (Senate  Report  of  1916), 
I  am  now  able  to  present  some  additional  and  more  recent  statistics, 
which,  though  largely  for  other  countries  than  the  United  States,  certainly 
emphasize  the  sinister  aspects  of  leprosy  occurrence  in  isolated  cases 
as  they  are  met  with  from  time  to  time  in  this  coimtry.  For,  whatever 
views  may  be  held  regarding  the  spread  of  the  disease,  no  one  can  question 
that  leprosy  foci,  once  thoroughly  established,  are  extremely  difficult,  if  not 
impossible,  to  eradicate.  The  literature  of  leprosy  is  widely  scattered  and 
difficult  of  access  to  those  who  suddenly  find  themselves  confronted  by  the 
necessity  of  the  highly  specialized  care  of  some  isolated  case  of  leprosy, 
usually,  in  this  country,  outside  of  Louisiana,  contracted  in  the  Philip- 
pines, Hawaii,  or  the  West  Indies. 

Among  the  more  important  works  which  throw  light  and  a  wealth  of 
useful  information  upon  the  etiology  of  this  obscure  disease,  mention 
requires  to  be  made  of  "A  Handbook  on  Leprosy,"  by  S.  P.  Impey,  M.D., 
late  chief  and  medical  superintendent  of  the  Robben  Island  Leper  Asylum, 


Cape  Colony,  South  Africa.  Another  very  useful  dissertation  is  a  report 
on  leprosy  in  Hongkong,  by  James  Cantlie,  M.A.,  F.R.C.S.,  Hongkong, 
1890.  Of  special  value  are  the  "Prize  Essays  on  Leprosy,"  issued  by  the 
New  Sydenham  Society  in  1897,  including,  first,  a  contribution  to  the 
history  of  leprosy  in  Australia,  by  J.  Ashburton  Thompson,  M.D. ;  and, 
second,  a  report  on  the  conditions  under  which  leprosy  occurs  in  China, 
etc.,  compiled  chiefly  during  1894,  by  James  Cantlie,  One  of  the  most 
thorough  investigations  ever  made  into  the  subject  is  a  report  of  the 
Leprosy  Commission  of  India  (Calcutta,  1893),  which  may  well  be  con- 
sidered a  model  for  a  similar  inquiry  in  this  country.  This  investigation 
includes  the  results  of  personal  examinations  and  observations  on  the 
geographical  distribution  of  leprosy  in  its  relation  to  climate,  soil  and 
race,  illustrated  by  properly  drawn  maps  visualizing  the  local  degree  of 
frequency  of  the  disease  throughout  India.  The  observations  on  the  local 
incidence  of  leprosy  are  amplified  by  an  extended  consideration  of  such 
involved  questions  as  hereditary  transmission  and  predisposition,  con- 
tagiousness, sanitation,  diet,  other  diseases,  and,  finally,  the  important 
question  of  proper  treatment.  Through  the  courtesy  of  G.  M.  Young,  Esq., 
Under-Secretary  to  the  Governor  of  India,  I  have  been  favored  with  a 
copy  of  this  valuable  report,  and  of  a  supplementary  memorandum  pre- 
pared by  a  special  committee  in  behalf  of  the  National  Leprosy  Fund. 

It  is  difficult  to  clearly  grasp  the  significance  of  much  of  the  general 
discussion  relating  to  leprosy  at  a  time  when  the  views  of  highly  respected 
authorities  were  widely  at  variance  both  as  to  the  cause  of  the  disease 
and  the  methods  of  its  transmission.  I  need  only  refer  to  the  treatise  on 
"Leprosy  and  Fish  Eating,"  by  Sir  Jonathan  Hutchinson,  and  to  even 
better  purpose  to  the  report  on  "Leprosy  and  Yaws  in  the  West  Indies," 
by  Gavin  Milroy,  a  fellow  of  the  Royal  College  of  Physicians,  London, 
1873;  or,  of  more  recent  date,  to  the  reports  on  "Nastin  and  Benzoyl- 
chloride  Treatment  for  Leprosy,"  by  Dr.  E.  P.  Minett,  Assistant  Govern- 
ment Bacteriologist  of  British  Guiana,  London,  1912.* 

Modern  Views  on  Segregation 
A  review  of  the  literature  clearly  emphasizes  the  inadequacy  of  the 
medical  and  general  scientific  considerations  of  a  disease  which,  partly 
because  of  its  obscurity  and  largely  because  of  its  more  intensive  limita- 
tion to  primitive  races,  has  not  attracted  the  attention  to  which  it  is  cer- 
tainly, by  every  himiane  consideration,  entitled  at  the  present  time.   Even 

♦The  modem  literature  of  leprosy  is  so  extensive  as  to  preclude  even  a  mere  mention  by  title  of  the 
most  important  contributions,  but  a  reference  requires  to  be  made  to  one  of  the  Prize  Essays  on  leprosy 
published  by  the  New  Sydenham  Society,  1895,  containing  also  an  important  paper  by  Doctor  (now  Sir) 
George  Newman,  on  "The  History  of  the  Decline  and  Final  Extinction  of  Leprosy  as  an  Endemic  Dis- 
ease in  the  British  Islands."  The  same  volume  includes  a  most  interesting  essay  on  "Conditions  Under 
Which  Leprosy  has  Declined  in  Iceland,"  by  Edward  Ehlers,  M.D.,  and  a  paper  on  "Leprosy  in  South 
Africa,"  by  S.  P.  Impey,  M.D.,  with  some  supplementary  observations  on  "Spontaneous  Recovery  from 
Leprosy,"  based  upon  self-cured  cases,  presented  to  the  medical  congress  held  in  Cape  Toivn.  Of  im- 
portance also  is  a  contribution  to  the  New  Orleans  Medical  and  Surgical  Journal  of  July,  1917,  on  "Early 
Manifestations  of  Leprosy,"  by  Doctor  Ralph  Hopkins,  in  medical  charge  of  the  Louisiana  Leper  Home. 
Invaluable  in  this  connection  are  the  special  reports  upon  leprosy  prepared  by  the  United  States  Public 
Health  Service,  being  the  contributions  made  by  the  surgeons  in  charge  of  the  United  States  Leprosy 
Investigation   Station   in   Hawaii. 


so  useful  and  otherwise  comprehensive  a  work  as  the  new  "Reference 
Handbook  of  the  Medical  Sciences"  limits  the  discussion  of  leprosy  by 
Dr.  Dyer  to  less  than  six  pages;  but  I  may  appropriately  quote  here  Dr. 
Dyer's  conclusion  that,  "The  sanitary  control  of  leprosy  should  be  prac- 
ticed by  every  government  for  the  protection  of  the  public  and  for  the 
care  of  the  leper.  Segregation  has  proved  the  best  method  of  checking  the 
spread  of  the  disease  and  this  is  the  basis  of  the  practice  in  most  coun- 
tries." He  therefore  remarks,  "National  leprosaria  will  solve  the  question 
of  leprosy  incidence,  and  the  laboratory  gives  promise  of  finding  some 
specific." 

It  was  largely  upon  this  principle  of  precedure  that  the  small  group 
of  men  who  appeared  before  the  Senate  Committee  in  1916  presented 
their  case  and  carried  their  point,  for  be  it  said  to  the  honor  of  the  United 
States  Cozigress  that  an  appropriation  was  promptly  made  of  $250,000,  an 
amoimt  fully  sufficient  for  the  purpose.  The  bill  was  signed  by  the  Presi- 
dent on  February  3,  1917. 

In  the  argvmients  presented  to  the  committee  emphasis  Avas  placed  upon 
the  international  aspects  of  the  disease  and  the  fact  that,  outside  of  the 
State  of  Louisiana,  most,  if  not  nearly  all,  of  the  sporadic  cases  of 
leprosy  in  the  United  States  had  been  contracted  in  foreign  countries  or  in 
our  non-contiguous  territories.  It  was  chiefly  on  this  grovmd  that  the 
Senate  Committee  made  a  favorable  recommendation,  it  being  clearly 
understood  that  it  was  not  the  intention  of  the  States  represented  to  place 
upon  the  Federal  Government  the  burden  of  care  in  the  case  of  leprosy 
clearly  or  unmistakably  of  native  origin.  This  conclusion  applies  par- 
ticularly to  the  State  of  Louisiana,  where  leprosy  has  been  met  with  for 
more  than  a  hundred  years  and  where  the  disease  has  its  largest  endemic 
center  in  the  United  States.* 

Leprosy  in  Louisiana 

The  Louisiana  Leper  Home  was  established  by  an  act  of  the  General 
Assembly  of  Louisiana,  passed  in  the  year  1894,  the  location  of  the  home 
being  near  Carville,  in  Iberville  Parish,  about  sixty  miles  from  New 
Orleans,  on  the  banks  of  the  Mississippi  River. 

The  nimiber  of  new  cases  admitted  to  the  Louisiana  Leper  Home  in 
1894  (being  opened  on  December  1st)  was  only  eight,  but  during  the  fol- 
lowing year  eighteen  cases  were  admitted,  and  since  that  time  the  number 
has  varied,  reaching  a  maximum  of  twenty-seven  new  cases  during  the 
year  1913.  The  average  number  of  cases  admitted  during  the  period  1895- 
1899  was  seven,  or  5.2  admissions  per  million  of  population  per  annum, 
which  compares  or  contrasts  with  an  average  of  twenty-one  cases  annually 
or  llA  admissions  per  million  during  the  five  years  ending  with  1917. 
The  number  remaining  in  the  institution  at  the  time  the  report  was  made 
in  April,  1916,  was  103,  or  the  largest  nimiber  on  record.   The  returns  for 

♦There  is  record  of  a  leper  hospital  at  New  Orleans  as  early  as  1785.  It  has  been  claimed  that  the 
disease  was  introduced  by  the  Acadian  refugees  from  Nova  Scotia  after  their  expulsion  by  the  English. 


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the  year  1919  are  not  available  at  this  writing,  but  they  will  subsequently 
be  inserted  as  a  matter  of  convenient  record.* 

The  Louisiana  data,  which  are  given  in  full  in  table  I  of  Appendix  B, 
seem  to  justify  the  conclusion  that  leprosy  is  increasing  in  Louisiana;  or, 
if  not,  that  the  niunber  of  ru)n-segregated  patients  is  larger  than  is  gener- 
ally assumed  to  be  the  case.  This,  as  I  understand  it,  is  the  view  held  by 
Dr.  Dyer,  whose  judgment  is  entitled  to  the  utmost  consideration.  It  may 
be  said  in  this  connection  that  leprosarium  admissions  depend  largely 
upon  the  reputation  of  the  institution  for  the  care  and  medical  treatment 
of  the  patients  as  well  as  for  the  beneficial  results  secured  in  particular 
cases. 

I^EPROSY  Admissions  by  Race,  Sex  and  Average  Age 

The  Louisiana  Leper  Home  is  in  many  respects  an  admirable  institu- 
tion, which  has  been  fortunate  enough  to  be  under  the  supervision  of  a 
hmnane  board  conscious  of  its  profoimd  obligations  towards  the  most 
afflicted  members  of  the  community.  It  has,  furthermore,  the  great  advan- 
tage of  constant  medical  supervision  on  the  part  of  Dr.  Ralph  Hopkins, 
who  makes  a  weekly  visit  to  the  institution,  and  more  often  if  urgently 
required.  The  table  following  presents  an  analysis  of  257  cases  admitted 
to  the  institution  during  the  period  1894-1915,  differentiating  the  type  of 
the  disease,  the  race  and  sex  of  the  patient,  and  the  average  age  on  admis- 
sion according  to  the  diagnosed  variety  of  leprosy : 

analysis  of  admissions  to  leper  home,  la. 

For  the  Period,  December  1,  1894,  to  December  31,  1915 

Average  Age  on  Admission  by  Type  of  Disease 


MALES 

FEMALES 

Type  of 

White 

Colored 

White 

Colored 

Disease 

No. 

Av 

.  Age  Yrs. 

No. 

Av.  Age  Yrs. 

No. 

Av.  Age  Yrs 

:.    No.   Av 

.Age  Yrs. 

Tubercular 

38 

32 

14 

39 

18 

42 

6 

41 

Anesthetic 

32 

28 

6 

34 

19 

35 

3 

27 

Mixed 

46 

33 

10 

41 

30 

36 

6 

31 

Trophic 

10 

36 

2 

53 

4 

31 

3 

58 

Unknown 

2 

40 

— 

■ — 

— 

— 

— 

— 

Total 

128 

32.0 

32 

39.5 

71 

37.1 

18 

38.1 

Ages  Unknown 

4 

— 

1 

— 

2 

— 

— 

— 

Males  and  Females 

No. 

Av.  Age  Yrs. 

Tubercular 

76 

36.4 

Anesthetic 

60 

31.0 

Mixed 

92 

35.0 

Trophic 

20  (x) 

41.7 

Unknown 

2 

40.0 

Total 

250 

35.0 

Age  Unknown 

7 

(x)    Includes  one  Chinese,  age  75.    (Male.) 

Data  from  Biennial  Reports  of  the  Board  of  Control. 

Varieties  of  Leprosy  in  Louisl\.na 
Of  the  257  admissions,  205,  or  79.8  per  cent.,  were  white  persons. 
The  corresponding  proportion  of  whites  in  the  total  population  of  Louisi- 

*The  number  remaining  in  1920  is  87. 

10 


ana  was  56.9  per  cent,  at  the  time  of  the  1910  census.  The  average  age 
on  admission,  disregarding  the  type  of  the  disease,  was  32  years  for  white 
males  and  39.5  years  for  colored  males.  For  white  females  the  average 
age  on  admission  was  37.1  years,  and  for  colored  females,  38.1  years. 
There  would,  therefore,  appear  to  be  a  tendency  towards  a  somewhat 
higher  age  on  admission  in  the  case  of  the  colored  patients. 

Combining  both  races  and  sexes,  of  the  257  admissions,  77,  or  30.0 
per  cent.,  were  of  the  clearly  differentiated  tubercular  variety,  62,  or  24,1 
per  cent.,  were  of  the  anesthetic  variety,  and  95,  or  37.0  per  cent.,  were  of 
the  mixed  variety,  the  proportions  varying  according  to  race  and  sex,  but 
it  is  safe  to  say  that  the  mixed  variety  is  the  predominant  type.  The  fact 
that  the  mixed  variety  predominates  complicates  the  question  of  treatment 
and  makes  segregation  even  more  important  than  would  ordinarily  be  the 
case.  The  mixed  variety  apparently  has  a  slightly  higher  average  age  on 
admission,  while  the  anestlietic  variety  has  a  lower  age  than  the  tubercular 
for  both  sexes  and  both  races  separately  considered. 

The  Fatality  Rate  in  Leprosy 
The  next  table  shows  an  analysis  of  the  experience  during  the  period 
1894-1915,  indicating  the  fatality  ratios  and  the  cures,  with  a  due  regard 
to  sex  and  type  of  disease: 

ADMISSIONS  TO  THE  LOUISIANA  LEPER  HOME 

According  to  Type  of  Disease,  Mortality,  and  Cures 
December  1,  1894,  to  December  31,  1915 

Males 


Type  of 

Admissions 

I 

)ied 

Disease 

No. 

No. 

% 

Tubercular 

52 

18 

34.6 

Anesthetic 

40 

9 

22.5 

Mixed 

58 

38 

65.5 

Trophic 

13 

7 

53.8 

Unknown 

3 

— 

- — 

Total 

166 

72 
Females 

43.4 

Tubercular 

25 

6 

24.0 

Anesthetic 

22 

9 

40.9 

Mixed 

37 

20 

54.1 

Trophic 

7 

4 

57.1 

Unknown 

— 

Total 

91 

39 

42.9 

Males  and  Females 

Tubercular 

77 

24 

31.2 

Anesthetic 

62 

18 

29.0 

Mixed 

95 

58 

61.1 

Trophic 

20 

11 

55.0 

Unknown 

3 

— 

Ci 

jred 

No. 

% 

2 

3.8 

4 

10.0 

1 

1.7 

4.2 


6  24.0 
4  18.2 
2        5.4 


12      13.2 


8  10.4 
8  12.9 
3        3.2 


Total 


257 


111      43.2 


11 


19        7.4 


Discharges  and  Cures 

The  interesting  fact  is  brought  out  by  this  table  that  of  the  total  male 
admissions,  numbering  166,  seven  cases,  or  4.2  per  cent.,  were  discharged 
as  cured.  Of  91  females,  twelve  cases,  or  13.2  per  cent.,  were  discharged 
as  cured,  but  it  is  hardly  safe  to  draw  far-reaching  conclusions  according 
to  the  type  of  the  disease  and  the  apparent  degree  of  curability,  with  refer- 
ence to  sex,  on  account  of  the  smaller  number  of  women  patients  under 
observation.  In  the  case  of  male  patients,  however,  it  is  significant  that  the 
proportion  of  deaths  should  have  been  highest  for  the  mixed  type  of  the 
disease,  or  65.5  per  cent,  of  the  admissions,  the  corresponding  percentage 
for  females  having  been  54.1.  For  the  tubercular  type  of  the  disease,  the 
mortality  rate  was  34.6  per  cent,  for  males  and  24.0  per  cent,  for  females. 
The  fatality  rate,  of  course,  is  largely  influenced  by  the  duration  of  treat- 
ment and  the  attained  age  of  the  lepers  under  segregation,  as  well  as  by 
the  rate  of  admission  of  new  cases.  No  definite  conclusions  can  be  drawn 
from  this  experience  as  to  the  greater  or  lesser  degree  of  curability  of 
specified  types  of  leprosy,  but  the  method  used  emphasizes  the  value  of 
an  extended  statistical  analysis  of  the  facts  derived  from  a  larger  area  of 
observation.  For  all  types  combined  the  mortality  rate  was  43.4  per  cent, 
for  male  patients  and  42.9  per  cent,  for  female  patients,  or  almost  the  same. 

Many  other  interesting  facts  are  brought  out  by  the  statistical  tables 
appended  to  this  discussion,  which  are  practically  self-explanatory.  With- 
out unduly  enlarging  upon  the  facts  as  disclosed  by  table  II,  Appendix  B, 
it  may  be  said  in  this  connection  that  the  age  period  at  which  the  larger 
proportion  of  leprosy  admissions  occurred  in  Louisiana  was  20-29.  At  this 
period  of  life  there  were  34  admissions,  or  20.5  per  cent,  of  the  total  of  166 
male  admissions,  while  of  91  females  the  greatest  number  was  admitted  at 
ages  40-49,  but  almost  the  same  niunber  was  admitted  at  ages  20-29.  A 
discussion  of  the  statistical  results  of  this  investigation  is  naturally  difficult 
on  account  of  the  race  factor,  which  can  not  be  safely  ignored,  but  an 
extended  consideration  of  which  would  unduly  trespass  upon  the  time 
available,  and  more  so  in  view  of  the  fact  that  the  details  are  given  in  the 
tables  in  the  appended  tabular  analysis. 

Absconding  Cases 
It  has  not  been  possible  for  me  to  deal  with  the  question  of  escapes, 
but  from  every  center  of  leprosy  the  information  is  clearly  to  the  effect 
that  escapes  are  not  only  inadequately  safeguarded  against  but  in  some 
cases  encouraged.  The  Early  case  of  the  District  of  Columbia  is  a  con- 
spicuous illustration  of  our  failure  to  recognize  the  menace  of  leprosy 
to  the  community  at  large.  Most  of  the  cases  apprehended  have  previously 
been  unrecognized  leper  residents  of  other  communities.  In  Louisiana  last 
year  fifteen  cases  absconded,  but  what  became  of  these  cases  is  not  known. 
In  California  last  year  at  least  three  cases,  and  probably  more,  escaped 
from   detention  hospitals.    It  is   always   a  foregone  conclusion  that  an 

12 


escaped  leper  will  be  apprehended  within  a  comparatively  short  period 
of  time  on  account  of  the  urgency  of  the  special  treatment  required  to 
bring  relief.  In  view,  however,  of  the  recognized  infectious  character  of 
the  disease,  or  its  transmission  from  person  to  person  by  actual  contact, 
the  danger  to  the  community  on  account  of  such  cases  is  real  and  not 
imaginary.* 

Deportations 

I  am  not  able  to  discuss  in  full  detail  the  question  of  deportations.  The 
reports  of  the  Surgeon  General  do  not  indicate  how  many  lepers  are  annu- 
ally deported.  Under  the  law  a  foreign-born  leper  must  be  a  resident 
of  this  country  five  years  before  he  acquires  a  settlement.  Most  of  the 
cases  of  foreign-born  lepers  have  been  residents  of  this  country  for 
many  years,  although  the  disease  was  unquestionably  contracted  abroad. 
Accurate  information  would  be  of  value,  for  unquestionably  leprosy  im- 
portations would  be  discouraged  if  the  facts  of  deportation  were  better 
understood.  It  would  also  be  of  value  to  have  the  duration  of  previous 
residence  in  this  country  accurately  ascertained  to  determine  whether  cases 
should  be  deported  that  now  are  a  burden  and  expense  to  communities  ill- 
provided  with  proper  facilities  for  leprosy  care.  The  question  may  be 
raised  in  this  connection  whether  our  methods  of  examination  for  leprosy 
at  quarantine  are  really  adequate  to  the  purpose.  It  does  not  appear  that 
special  emphasis  is  placed  upon  the  urgency  of  ascertaining  cases  of 
leprosy  in  the  incipient  stage  of  the  disease.  It  is  possible  that  the  Bureau 
of  Immigration  has  information  on  the  subject,  for  the  records  should 
show  the  number  of  cases  refused  admission  to  this  country  on  account  of 
leprosy,  as  well  as  the  number  deported. 

Leprosy  in  the  Young 

One  important  phase  of  the  subject  is  leprosy  in  the  young.  There  are 
in  this  country  at  the  present  time  a  number  of  very  suggestive  cases  of 
children  suffering  from  leprosy  evidently  contracted  from  leprous  parents. 
There  are  or  were  two  or  three  such  children  at  the  Alameda  County 
Hospital,  Oakland,  Cal.,  and  there  are  at  present  two  such  children  at 
Phillipsburg,  N.  J.,  ill-provided  with  the  required  special  institutional 
care.  Since  a  leper  under  certain  conditions  may  live  for  many  years  with 
the  disease  in  a  quiescent  or  arrested  stage  the  pecuniary  aspects  of  this 
question  are  a  matter  of  serious  importance  to  the  localities  concerned. 

*The  importance  of  this  observation  is  illustrated  by  the  very  recent  case  of  Willard  Centliver,  a  leper, 
who  surrendered  to  the  authorities  of  the  City  of  Washington,  as  reported  in  the  Washington  Post  of 
March  28,  1920.  He  had  arrived  in  Washington  a  few  days  before  from  Birmingham,  Alabama,  having 
made  the  trip  in  a  Pullman  car,  but  he  had  destroyed  the  car  check  so  as  to  preclude  the  identification 
of  the  method  by  which  he  had  evaded  detection.  This  man  was  accepted  for  army  service  in  New 
Orleans  in  1917,  having  subsequently  been  transferred  to  Camp  Beauregard,  Louisiana.  His  condition  being 
ascertained,  he  was  sent  to  the  Louisiana  Leper  Home  from  which  he  escaped  and  went  to  Houston,  Texas. 
From  there  he  returned  to  New  Orleans  and  subsequently  by  way  of  Birmingham  reached  Washington,  where 
he  entered  a  clinic  and  reported  his  condition.  He  could  give  no  explanation  as  to  how  or  where  he  had 
contracted  the  disease. 


13 


Treatment  and  Cure 
The  question  of  treatment  and  cure  does  not  fall  within  the  present 
discussion  but  it  has  an  important  bearing  upon  the  problem  of  leprosy 
increase  in  that  the  numbers  remaining  are  naturally  determined  in  part 
by  the  results  of  institutional  care.  There  is  apparently  a  distinct  tendency 
towards  a  larger  proportion  of  cases  discharged  as  cured,  or  certainly  in 
an  arrested  condition  of  the  disease,  justifying  a  diagnosis  of  at  least 
relative  harmlessness  to  the  community  at  large.  In  proportion,  however, 
as  cases  to  an  increasing  extent  are  discharged  as  cured  the  number  remain- 
ing would  indicate  a  diminished  frequency  of  leprosy  in  the  community, 
although  the  contrary  might  be  the  case.  This  fact  is  frequently  overlooked 
in  discussions  of  leprosy  increase,  and  care  is  therefore  necessary  in  con- 
sidering the  statistical  results. 

Leprosy  in  California 
One  of  the  most  important  centers  of  leprosy  in  the  United  States  is 
the  Isolation  Hospital  at  San  Francisco,  where  generally  from  fifteen  to 
twenty  lepers  are  segregated  by  the  County  of  San  Francisco,  there  being 
in  addition  some  nine  lepers  at  the  County  Hospital  of  Alameda  County, 
near  Oakland.  The  leprosy  cases  in  San  Francisco  show  no  material  in- 
crease during  recent  years,  bift  there  are  reasons  for  believing  that  cases 
are  not  effectively  segregated,  but  apprehended  in  other  counties,  as  best 
illustrated  by  some  very  interesting  apprehensions  in  Fresno,  in  the  heart 
of  the  San  Joaquin  Valley;  and  even  more  so  by  the  Los  Angeles  County 
Hospital,  where  at  the  present  time  five  lepers  are  under  control.  Details 
regarding  the  San  Francisco  cases  are  appended  hereto  (table  HI,  Ap- 
pendix B),  but  it  must  be  kept  in  mind  that  it  is  always  more  difiGcult  to 
secure  trustworthy  data  for  institutions  which  care  for  only  a  small  number 
of  cases,  not  on  the  basis  of  adequate  leprosy  segregation  but  rather  on  the 
principle  of  isolation  and  quarantine  control. 

Leprosy  in  Massachusetts 
Some  exceptionally  interesting  data  are  available  for  the  Massachu- 
setts Leper  Colony  at  Penikese  Island,  in  Buzzard's  Bay,  where  the  num- 
ber under  segregation  is  generally  about  twelve,  but  probably  some- 
what higher  at  the  present  time,  a  maximum  having  been  reached  in 
1913,  when  fifteen  cases  were  under  segregation.*  Some  interesting  details 
of  racial  origin,  age,  and  type  of  disease,  are  also  included  in  the  appen- 
dix (table  IV,  Appendix  B.) 

Leprosy  in  the  United  States  Registration  Area 
The  foregoing  statistics  indicate  the  best  sources  of  leprosy  informa- 
tion for  the  United  States,  but  there  can  be  no  question  of  doubt  that  the 
disease  is  widely  scattered  and  that  obscure  cases  occur  here  and  there, 
though  frequently  erroneously  diagnosed  or  not  recognized  at  all  except 

♦Number  under  segregation  on  January  1,  1920  was  13,  with  2  more  cases  reported  during  the  month. 

14 


in  the  terminal  stage  of  the  disease.  It  may  be  pointed  out  in  this  connec- 
tion that  in  the  United  States  registration  area,  with  a  population  of 
about  82,000,000  in  1918,  there  occurred  twenty-four  deaths  from  leprosy, 
equivalent  to  a  rate  of  0.29  per  million  of  population.  The  rate  in  the 
registration  area  has  apparently  increased  gradually  from  0.13  in  1900 
to  0.19  in  1910,  and,  as  stated,  to  a  maximum  figure  of  0.29  in  1918. 
(Table  V,  Appendix  B.)* 

Revised  Estimate  of  Leprosy  Cases  in  the  United  States 

If  the  normal  death  rate  of  leper  cases  is  placed  at  80  per  1,000  tmder 
segregation,  then  the  twenty-four  deaths  from  leprosy  which  occurred  in 
the  United  States  in  1918  would  be  equivalent  to  300  probable  cases  of 
leprosy  in  the  registration  area,  and  if  this  figure  is  applied  to  the  con- 
tinental United  States,  the  number  of  leper  cases,  on  a  very  conservative 
basis,  is  not  less  than  400. 

The  distribution  of  leprosy  deaths  in  the  registration  States,  by  single 
years,  since  1900,  is  given  in  table  VI  of  Appendix  B,  but  the  fact  must  not 
be  overlooked  that  some  of  the  States  have  been  included  in  the  registration 
area  during  recent  years  only.  The  inadequacy  of  this  return  is  made 
clear  by  the  statistics  for  the  State  of  New  York,  where  unquestionably 
a  larger  number  of  deaths  from  leprosy  occur  than  the  recorded  two 
deaths,  for  illustration,  during  1918.  There  has  been  for  many  years 
an  attitude  not  far  from  indifference  on  the  part  of  the  New  York  authori- 
ties towards  the  imperative  medical  and  humane  duty  of  segregation, 
which  is  so  much  more  lamentable  since  it  is  safe  to  assume  that  there  are 
certainly  not  less  than  thirty  and  possibly  as  many  as  fifty  cases  of  leprosy 
in  the  city  of  New  York  at  any  given  time.  That  cases  in  the  city  of  New 
York  are  of  national  concern  is  shown  by  sporadic  outbreaks.  Cases  in 
New  Jersey,  for  illustration,  have  been  directly  traceable  to  leprosy  con- 
tact on  Blackwell's  Island.  There  are  at  the  present  time  two  leper  chil- 
dren in  Phillipsburg,  N.  J.,  whose  mother  died  from  the  disease  in  the 
city  of  New  York.f 

If,  therefore,  the  available  statistical  evidence  is  not  entirely  conclusive 
it  is  certainly  extremely  suggestive  of  a  possible,  though  slowly  increasing, 
frequency  of  this  most  dreaded  of  all  human  afflictions.  The  experience 
which  has  been  had  in  other  countries  proves  conclusively  that  leprosy 
increases  as  long  as  segregation  is  neglected,  but  that  the  disease  slowly 
declines  when  the  cases  are  brought  under  control  in  one  or  more  care- 
fully supervised  institutions  such  as  the  act  of  February  3,  1917,  provides 
shall  be  established  in  the  United  States  under  the  direction  of  the  United 
States  Public  Health  Service. 

*0f  course,  not  all  lepers  die  of  leprosy,  so  that  the  reported  figure  is  an  understatement  of  the 
whole  truth  of  leprosy  occurrence  in  the  registration  area.    See  table  IX,  Appendix  B,  for  Barbados. 

tFor    the    official   viewpoint    that    leprosy    is    not    contagious    or    infectious    in    this    climate,    see    J.    A. 
M.  A.   of  November  13,   1897,   p.   1021.   and  November  27,   1897,   p.   1126. 

15 


Urgent  Need  for  a  Federal  Leprosarium 
The  urgency  of  a  federal  leprosarium  is  not  questioned  by  anyone 
familiar  with  the  facts.  It  requires  only  to  be  considered  that  during  the 
period  1907-18  there  have  been  not  less  than  138  deaths  from  leprosy 
in  the  United  States  registration  area,  which  is  exclusive  of  a  considerable 
rural  and  Southern  section  in  which  leprosy  cases  are  likely  to  occur. 
Delay  in  the  establishment  of  a  federal  institution  for  the  care  of  lepers 
must  therefore  be  considered,  on  humane  as  well  as  on  medical  grounds, 
a  wrongful  indifference  on  the  part  of  those  who  are  responsible  for 
the  execution  of  the  law".  The  obstacles  to  the  selection  of  a  suitable 
site  can  not  be  considered  serious,  and  least  so  in  the  case  of  Ship  Island, 
Miss.,  where  there  are  suitable  buildings  which  could  long  since  have  been 
converted  into  a  most  useful  institution  for  the  care  and  relief  at  least  of 
interstate  and  international  leprosy  cases  throughout  the  South.  Before  1 
enlarge  upon  the  practical  aspects  of  the  question  of  adequate  care  under 
segregation  it  may  not  be  out  of  place  to  direct  attention  to  certain  facts 
of  leprosy  occurrence  throughout  the  Western  Hemisphere  which  bear 
directly  upon  our  own  problems  at  home. 

Leprosy  in  Canada 

There  has  for  many  years  been  a  very  limited  leprosy  center  in  the 
Province  of  New  Brunswick,  dating  back  certainly  as  far  as  1815,  and  prob- 
ably to  a  much  earlier  period.  As  many  as  thirty-two  lepers  were  segre- 
gated at  Shell  Island  about  1844,  and  these  were  later  transferred  to  the 
present  leprosarium  at  Tracadie,  where  twenty-one  lepers  were  cared  for 
in  1863.  As  the  result  of  segregation  the  number  of  patients  has  gradually 
diminished  to  twenty-four  in  1898  and  fourteen  in  1916  with  no  new  admis- 
sions for  the  two  years  preceding  the  date  of  the  last  return.  In  1907  the 
Canadian  government  assimied  federal  control  over  all  leprosy  cases,  and 
a  lazaretto  was  established  at  Darcy  Island,  B.  C,  for  the  care  of  cases  on 
the  Pacific  coast.  There  have  been  sporadic  cases  of  leprosy  in  Manitoba, 
chiefly  of  Icelandic  or  Scandinavian  origin.  It  may  be  questioned  whether 
there  are  more  than  twenty-five  active  cases  of  leprosy  throughout  Canada 
at  the  present  time.  There  were  five  cases  at  Darcy  Island  in  1919  and  thir- 
teen cases  at  Tracadie. 

Leprosy  in  Cuba 

In  Cuba  there  occur  probably  fifty  deaths  from  leprosy  per  annum, 
equivalent  to  a  rate  of  20  per  million  of  population.  As  far  as  it  is  pos- 
sible to  judge  the  disease  is  slightly  on  the  increase,  partly  because  of 
the  lack  of  adequate  methods  of  segregation,  although  probably  more  is 
done  by  the  Republic  of  Cuba  than  in  the  United  States.  In  Cuba  leprosy 
appears  to  affect  chiefly  the  white  population,  for  in  1914  there  were 
thirty-five  deaths  of  white  lepers  to  ten  deaths  from  leprosy  among  the 
negroes.    (See  tables  VII  and  VIII,  Appendix  B.)  * 

♦According  to  the  Bulletin  of  the  Pan-American  Union  for  September,  1916  "The  construction  of  a 
new  leper  hospital  building  was  provided  for  at  an  expense  not  exceeding  three  hundred  thousand  dol- 
lars." In  January,  1917,  the  lepers  under  segregation  at  the  lazaretto  in  the  city  of  Havana  remon- 
strated against  their  proposed  removal  to  the  new  institution  at  Mareal.  Out  of  one  hundred  and  leventy- 
four  lepers,  it  is  said  twenty  escaped. 

16 


Leprosy  in  Porto  Rico 

In  Porlo  Rico  leprosy  is  fairly  common,  the  number  of  known  cases 
being  thirty-nine  in  1919,  or  30.9  per  million  of  population.  This  com- 
pares with  about  154  known  leper  cases  per  million  population  for 
Cuba,  but  the  evidence  of  an  increase  in  the  frequency  of  the  disease  is 
much  more  pronounced  for  Porto  Rico,  or,  for  illustration,  a  rate  of  17.3 
for  1905  contrasts  with  24.3  for  1912  and  30.9  for  1919.  (See  table  IX, 
Appendix  B.)  * 

Leprosy  in  Panama  Canal  Zone 

In  the  Panama  Canal  Zone  leprosy  is  also  of  relatively  common  occur- 
rence, the  lepers  being  segregated  in  a  settlement  at  Palo  Seco,  near  the 
canal  entrance,  including,  however,  admissions  of  Panamanians  from  the 
republic  at  large.  The  number  of  cases  remaining  under  observation  in 
1918  was  seventy-six,  or  693  per  million  of  population,  a  very  marked 
excess  over  the  known  rates  for  Cuba  and  Porto  Rico.  There  were  eight 
deaths  from  leprosy  in  1918,  equivalent  to  a  rate  of  72.9  per  million  of 
population,  which  compares  with  the  rate  of  19.7  for  Cuba  for  the  year 
1914.  The  returns  for  the  Panama  Canal  Zone  also  indicate  an  increase, 
at  least  in  the  recorded  frequency  of  leprosy,  the  rate  having  been  137.1 
for  1907,  348.6  for  1913,  and  692.6  for  1918.  The  Palo  Seco  returns, 
however,  are  not  entirely  complete  in  that  sporadic  cases  of  leprosy  are 
occasionally  taken  care  of  in  the  hospitals  of  the  Panama  Canal  Zone. 
It  may  be  said  in  this  connection  that  the  prevailing  variety  of  the  disease 
in  Panama  is  tubercular,  or  twenty-four  deaths  out  of  thirty-three  during 
the  period  1907-1915;  while  an  overwhelming  proportion  of  admissions 
is  represented  by  native  Panamanians  and  negroes,  there  having  been  only 
three  deaths  of  white  persons  during  the  period  under  review  out  of  a 
total  of  thirty-three  deaths  of  all  races  and  nationalities.  Two  of  the  white 
decedents  were  natives  of  the  United  States. 

The  Senate  report  on  leprosy  contains  much  information  concerning 
the  frequency  of  the  disease  throughout  the  West  Indies,  which  to  enlarge 
upon  would  unduly  trespass  upon  the  time  available  for  the  present  dis- 
cussion. It  seems  advisable,  however,  to  briefly  direct  attention  to  the 
leprosy  returns  for  certain  countries  of  South  America,  which  are  deserving 
of  more  consideration  than  has  heretofore  been  given  to  the  relative  fre- 
quency of  the  disease  in  the  Pan-American  republics.  (See  tables  X  and 
XI,  Appendix  B.) 

*The  lepers  of  Porto  Rico  are  isolated  on  Cabras  Island  at  the  entrance  of  San  Juan  Bay.  In  1917, 
however,  this  institution  had  only  thirty-four  patients.  The  Journal  of  the  Porto  Rico  Medical  Association 
quoted  in  the  Journal  of  the  American  Medical  Association  of  1918  contains  the  report  of  a  committee 
appointed  to  investigate  leprosy  conditions  in  Porto  Rico.  This  report  brought  to  light  decidedly  unsatis- 
factory conditions,  particularly  as  to  the  water  supply  and  acessibility.  The  committee  recommended  that 
the  present  site  be  abandoned  and  that  the  lepers  be  removed  "to  a  fertile  portion  of  the  mainland  of 
Porto  Rico,"  and  that  "principles  of  modern  sanitary  management  be  applied  to  the  care  and  treatment  of 
the  disease  in  place  of  the  present  state  of  hopeless  isolation."  The  New  York  Times  of  April  13,  1919, 
contains  an  account  of  this  colony  reflecting  seriously  upon  existing  conditions,  stating  the  sanitary  con- 
ditions to  be  deplorable  and  directing  attention  to  the  totally  inadequate  medical  supervision.  The  article 
concludes  with  the  statement  that  "Common  human  kindness  should  prompt  the  authorities  of  Porto  Rico 
to  have  the  unfortunates  transferred  to  some  other  place,  where  at  least  they  could  keep  dry  in  damp 
weather."   and,    it  is   said,    "Surely   these   poor   outcasts   need   some   one's   help." 

17 


Leprosy  in  Rio  de  Janeiro 
For  Rio  de  Janeiro  the  statistics  indicate  a  relative  mortality  from 
leprosy  of  about  30  per  million  of  population,  there  having  been  twenty- 
three  deaths  from  this  disease  in  1918.  The  returns  are  available  since 
1890  and  indicate  neither  a  pronounced  tendency  towards  an  increase  nor 
a  decided  diminution.  It  may  therefore  be  said  that  the  disease  has 
apparently  reached  a  stationary  condition,  in  Rio  de  Janeiro  at  least, 
while  for  Recife  (Pernambuco),  the  available  data  indicate  a  decided 
decrease  since  1907,  from  a  rate  of  112.9  per  million  of  population  to  37.5 
in  1917.    (See  table  XII,  Appendix  B.) 

,  Leprosy  in  Sao  Paulo 

For  the  city  of  Sao  Paulo,  however,  the  returns  are  less  reassuring, 
for  there  the  condition  also  appears  to  be  apparently  a  stationary  one. 
In  1901  the  nmnber  of  deaths  from  leprosy  was  equivalent  to  17.5  per 
million,  but  by  ]  910  the  rate  had  increased,  probably  due  largely  to  more 
accurate  methods  of  reporting,  to  65.6.  In  1917  the  rate  was  57.5  per 
million,  but  apparently  the  changes  in  the  rates  can  not  be  relied  upon  as 
a  definite  indication  of  an  increase  or  decrease  in  the  frequency  of  the 
disease.    (See  table  XIII,  Appendix  B.) 

Leprosy  in  Brazil 

Some  interesting  statistics  are  available  for  the  Federal  District  of 
Rio  de  Janeiro,  for  the  period  1909-18,  indicating  a  relative  annual  mor- 
tality from  leprosy  of  27.9  per  million  of  population  for  males  and 
18.8  for  females.  The  rate  increases  with  age,  as  shown  by  a  table 
hereto  appended,  from  a  minimum  mortality  in  infancy  to  a  maximmn 
mortality  in  advanced  adult  life.    (Table  XIV,  Appendix  B.) 

In  addition,  there  is  included  a  table  of  leprosy  mortality  in  the 
Federal  District  of  Rio  de  Janeiro,  by  nativity,  showing,  at  least  for  the 
male  population,  a  decided  tendency  towards  a  higher  rate  on  the  part 
of  the  natives,  but  the  data  are  not  sufficient  for  entirely  safe  conclusions. 
(Table  XV,  Appendix  B.)  They  would  seem  to  indicate,  however,  a  lesser 
disease  liability  on  the  part  of  the  native  Brazilians  than  on  the  part  of 
the  foreign-born.  The  same  conclusion  applies  to  the  relative  frequency 
by  race,  but  in  this  case  the  fact  must  not  be  overlooked  that  the  age  dis- 
tribution of  the  mixed  population  may  possibly  be  much  at  variance  with 
the  corresponding  distribution  of  the  pure  white  or  black  population. 
(See  table  XVI,  Appendix  B.)  * 

*Under  date  of  August,  1919,  a  report  was  issued  to  the  eJFect  that  a  new  and  model  leprosarium 
was  under  construction  in  Santo  Angelo  "which  will  be  the  best  of  its  kind  in  all  South  America  and 
have  all  facilities  for  the  isolation  and  treatment  of  lepers."  Under  date  of  January  10,  1920,  the 
American  Medical  Association,  quoting  from  a  Brazil  medical  periodical,  states  that  a  committee  had  reported: 
"We  question  whether  it  is  advisable  to  leave  lepers  in  their  homes  under  special  surveillance  or  [not  better] 
to  segregate  them."  Further  directing  attention  to  the  beneficial  results  of  segregation  in  Norway,  where  in 
fifty-seven  years  the  number  had  been  reduced  to  less  than  three  hundred  cases.  It  is  said  that  "In 
Norway  the  central  government  has  control  over  the  whole  country,  and  uniform  methods  of  surveillance 
could  be  applied."  The  report  however,  emphasizes  that  conditions  in  Brazil  are  very  different,  there 
being  no  uniformity  possible  in  the  twenty  states  of  Brazil  under  existing  conditions.  Hence  "the  con- 
clusion that  segregation  is  the  only  practical  system  for  the  prophylaxis  of  leprosy."  But  the  committee 
urges   that   the   leprosariums  should  be   easy   of  access   to   friends  and   attractive. 

18 


Leprosy  in  Argentine  Republic 
Some  very  interesting  statistics  are  also  available  for  Argentina,  where 
a  national  conference  on  leprosy  was  held  in  Buenos  Aires  in  1906,  when 
the  number  of  lepers  throughout  Argentina  was  returned  as  724.  Of  this 
number,  272  cases  were  found  in  the  Province  of  Corrientes,  144  in  the 
Province  of  Buenos  Aires,  and  123  in  the  federal  capital.  Between  1906 
and  1916  there  were  350  cases  of  leprosy  treated  in  the  hospitals  of  the 
Republic  of  Argentina.* 

Leprosy  in  Venezuela 
In  Venezuela,  so  far  as  the  death  rate  can  be  relied  upon,  there  is 
apparently  a  tendency  towards  a  decline,  for  the  highest  rate,  for  1905, 
was  returned  as  31.0  per  million  of  population,  while  by  1912  it  had  been 
reduced  to  22.5,  and  in  1918  to  9.8.  In  the  meantime,  however,  the  num- 
ber of  inmates  at  the  leper  asylum  has  not  undergone  a  material  change, 
there  being  666  cases  in  1907,  or  251.3  per  million  of  population,  against 
582,  or  211.2  per  million,  in  1912,  and  753,  or  262.5  per  million,  in  1918. 
(See  table  XVII,  Appendix  B.)t 

Leprosy  in  Barbados 
Thus  the  evidence  is  quite  sufficient  to  emphasize  the  conclusion  that 
leprosy  in  the  Western  Hemisphere  is  endemic  and  possibly  on  the  in- 
crease, and  that  therefore  no  country,  and  particularly  no  port  of  entry, 
can  be  considered  safe  or  inunune  against  the  risk  of  a  possible  further 
introduction  of  the  disease  into  this  country  from  nearby  republics  with 
which  our  commercial  relations  are  constantly  expanding.^  The  disease 
prevails  in  Costa  Rica,  in  Venezuela,  on  the  west  coast  of  South  America,  in 
Dutch  Guiana,  and  in  practically  all  the  West  Indies,  and  particularly  in  the 
island  of  Barbados,  which  is  a  source  of  considerable  emigration  to  this 
country.  In  Barbados  the  disease  appears  to  be  stationary,  but  evidence 
is  not  wanting  that  lepers  from  Barbados  have  been  apprehended  in  the 

♦According  to  the  Journal  of  the  American  Medical  Association  for  November  15,  1917,  no  successful 
attempt  is  apparently  made  in  Argentina  to  isolate  all  the  lepers  but  it  is  planned  "to  construct  a  large 
leprosarium  with  accommodations  for  five  hundred  patients  in  the  Chaco  district."  The  report  protests 
against  an  inland  leper  colony  of  this  kind  on  the  ground  that  "it  is  just  adding  fuel  to  the  fire,"  and 
suggests  that  "the  leper  colony  should  bo  on  some  island  apart  from  the  centers  of  population  and  every 
member  should  be  given  land.  It  should  be  a  free  farming  community  except  that  the  inmates  should  not 
be  allowed  to  leave  the  island." 

tThere  are  two  leprosariums  in  operation  in  Venezuela.  The  largest  is  on  the  Isla  de  Providencia, 
located  just  outside  of  the  harbor  of  Maracaibo,  with  accommodations  for  seven  hundred  patients.  .  The 
other  is  at   Cape   Blanco,  about   four  miles   from   Lagiaira. 

JThe  most  interesting  statistics  of  leprosy  are  those  available  for  certain  provinces  of  India.  Accord- 
ing to  the  census  of  the  Northwest  Frontier  Province  there  were  three  hundred  and  forty-four  cases  of 
leprosy  in  1881,  diminishing  to  two  hundred  and  seventy-six  in  1891,  increasing  slightly  to  two  hundred 
and  ninety-four  in  1901  and  diminishing  again  to  two  hundred  and  eighty-two  by  1911.  It  is  observed 
in  the  return  that  "in  the  case  of  leprosy  we  could  find  no  persistent  tendency  in  any  direction  towards 
an  increase  or  a  decrease  in  the  frequency  of  the  disease."  But  in  this  connection  it  is  said  that  "it 
is  in  the  case  of  leprosy  that  the  danger  of  wilful  concealment  is  greatest,  especially  when  the  leper  is 
a  female  of  respectable  status."  This  would  explain  the  lower  ratio  of  women  lepers  almost  invariably  met 
with  where  trustworthy  data  are  available."  It  is  pointed  out  that  "errors  of  diagnosis  no  doubt  detract 
from  the  accuracy  of  the  figures,  for  it  is  often  difficult  to  distinguish  leprosy  from  other  diseases  which 
exhibit  similar  symptoms,  such  as  leucoderma  and  syphilis."  In  this  connection  there  may  be  quoted  the 
further  observation  that  "The  causes  which  predispose  to  the  disease  do  not  seem  to  have  been 
accurately  determined;  and  no  correspondence  could  be  traced  between  the  physical  and  climatic  con- 
ditions or  between  the  race  or  the  staple  diets  of  the  inhabitants  of  the  tracts  of  India  in  which  leprosy 
was  found  to  be  especially  common."   (See  appendix  A  and  table  XIX,  Appendix  B.) 

19 


United  States.  During  the  period  1890-1917,  426  lepers  have  died  in 
Barbados,  and  of  this  number,  246  were  males  and  180  were  females,  an 
overwhelming  majority  of  the  cases  being  of  the  tubercular  variety,  or 
291  out  of  a  total  of  426.  The  average  duration  of  treatment  was  longest 
in  the  anesthetic  type,  or  9.6  years  for  males  and  11.5  years  for  females; 
but  for  the  tubercular  type  the  average  length  of  treatment  was  only  4.5 
years  for  males  and  4.8  for  females.  The  Barbados  figures  are  of  special 
value  in  that,  through  the  kindness  of  the  authorities,  I  have  been  fur- 
nished with  a  return  in  detail  as  to  the  causes  of  death,  with  distinction 
of  type,  the  facts  being  given  in  table  XVIII,  Appendix  B,  appended  hereto 
as  an  interesting  contribution  to  a  phase  of  the  leprosy  subject  which  has 
heretofore,  received  totally  inadequate  consideration.  In  many  of  the  discus- 
sions of  leprosy  it  is  not  clear  whether  the  references  are  to  lepers,  or  deaths 
from  leprosy.  As  shown  by  the  Barbados  returns,  of  the  total  number  of 
deaths  of  lepers  from  all  causes,  or  426,  the  number  of  deaths  from  causes 
other  than  leprosy  was  165,  or  38.7  per  cent. 

National  Conference  on  Leprosy  in  Argentina* 
These  considerations  suggest  the  urgency  of  a  much  more  qualified 
and  extended  interest  in  the  leprosy  problem  than  prevails  at  the  present 
time.  It  is  twenty-two  years  since  the  first  leprosy  conference  was  held 
in  Berlin,  which  was  followed  by  the  Bergen  conference  in  1909,  and  it 
is  nearly  fourteen  years  since  the  great  National  Leper  Conference  was 
held  in  the  Argentine  Republic.  The  report  on  that  conference,  by  Dr. 
Carlos  G.  Malbran,  constitutes  an  invaluable  source  of  trustworthy  in- 
formation amplified  by  interesting  maps  illustrating  the  relative  frequency 
of  leprosy  occurrence  in  the  sections  of  the  Argentine  Republic  most 
affected  by  the  disease. 

Geographical  Distribution  in  Brazil 
Another  valuable  report  on  the  geographical  distribution  of  leprosy 
in  South  America  has  been  made  by  Dr.  Carlos  Da  Costa  Ribeiro  under 
date  of  May,  1918,  to  the  Secretary  of  the  Interior  and  Justice  of  Brazil. 
This  report  includes  a  map  illustrating  the  distribution  of  leprosy  through- 
out the  State  of  Ceara  for  the  year  1918,  indicating  the  unsuspected  fre- 
quency occurrence  of  the  disease,  made  even  more  suggestive  by  a  map 
of  the  city  of  Fortaleza,  showing  the  distribution  of  existing  cases  through- 
out the  entire  community. 

Urgency  of  a  Broader  National  Interest 
Conferences  and  reports  of  this  kind  are  in  marked  contrast  to  our  own 
indifference  to  a  subject  which  should  arouse  the  medical,  general  scien- 
tific, and  himianitarian  interests  in  all  who  are  concerned  with  problems 
of  health  and  human  welfare.  For  a  time  the  United  States  Public  Health 
Service  published  an  important  series  of  special  reports  on  the  results 

♦Conforenca  Sobre  la  Lepra,  Buenos  Aires,  1908. 

20 


of  the  work  at  the  leprosy  investigation  station  in  Hawaii,  but  apparently 
in  recent  years  little  has  been  done  that  is  entitled  to  special  consideration. 
There  is  an  immense  mass  of  information  which  has  not  been  subjected 
to  critical  analysis  or  brought  within  the  reasonable  compass  of  a  report 
readily  within  the  understanding  of  those  who  are  seriously  concerned 
with  the  question  as  to  whether  the  disease  is  actually  on  the  increase  in 
this  country  and  the  enhanced  risk  of  its  introduction  from  abroad. 

Recent  Cases  of  Leprosy  Throughout  the  United  States 
Without  enlarging  further,  for  the  time  being,  upon  the  international 
aspects  of  leprosy  occurrence,  there  is  presented  here  a  smnmary  statement 
of  the  cases  of  leprosy  reported  in  this  country  since  April,  1916*. 

This  formidable  list  of  about  250  cases  can  not  be  considered  complete 
or  free  from  unavoidable  duplications.  The  reports  of  the  United  States 
Public  Health  Service  give  no  indication  whatever  as  to  the  personal  facts 
of  most  of  the  cases,  so  that  one  report  can  not  be  checked  by  another.  It 
would  be  very  desirable  if  in  every  case  the  Public  Health  Service  would 
give  the  initials  of  the  patient  and,  if  possible,  some  very  simple  data  as 
to  the  nativity  and  racial  origin,  the  age  and  sex,  and  the  type  of  the 
disease. 

Urgency  of  a  More  Qualified  Professional  Interest 
The  reports  emphasize  the  need  of  a  better  knowledge  regarding  the 
diagnostic  indications  of  leprosy  if  serious  errors  are  to  be  avoided. 
Reference  may  here  be  made  to  an  article  in  the  Brazilian  Archives  of 
Medicine  for  November,  1918,  on  incipient  leprosy,  in  which  Mourao 
described,  with  illustrations,  what  he  calls  "A  New  Sign  of  Leprosy,"  the 
details  of  which  are  set  forth  in  a  brief  article  in  the  Journal  of  the 
American  Medical  Association.  If  there  is  much  need  of  better  diagnosis, 
there  is  the  utmost  urgency  for  a  better  understanding  of  the  exact  facts 
of  leprosy  occurrence  on  the  part  of  the  general  public.  It  is  unfortu- 
nately true  that  many  of  the  cases  reported  are  set  forth  in  sensational 
terms,  causing  undue  alarm  on  the  part  of  those  who  can  not  possibly  be 
expected  to  understand  the  essential  facts  of  a  disease  which,  fortunately, 
is  still  of  rare  occurrence  in  this  country.  Conversely,  however,  there  is 
as  much  danger  in  underrating  the  importance  of  isolated  cases,  as,  for 
illustration,  in  the  statement  by  the  late  surgeon-general  of  the  United  States 
Public  Health  Service  with  reference  to  the  Early  case,  that  "though 
leprosy  is  a  disease  to  be  dreaded  it  is  not  a  national  menace"  in  the  same 
sense  that  venereal  diseases,  etc.,  are,  which,  though  true,  leads  neverthe- 
less to  erroneous  conclusions  on  the  part  of  the  general  public.f  Leprosy- 
is  a  serious  menace  to  this  nation  and,  however  much  guarded  against  by 
modern  methods  of  sanitary  living  and  sanitary  precautions,  it  is  a  danger 
to  any  one  and  all  who  may  have  the  misfortune  to  come  in  contact,  know- 

*Most  of  these  cases  are  from  the  weekly  Sanitary  Reports  of  the  United  States  Public  Health  Service. 
tSee  footnote  on  page  13. 

21 


ingly  or  unknowingly,  with  patients  suffering  from  the  disease  from  its 
incipient  to  its  terminal  stage.  I  can  not  do  better  than  quote  in  this  con- 
nection from  a  cable  despatch  to  the  New  York  Sun,  dated  Honolulu, 
November  11,  1919,  a  part  of  a  pitiful  story  of  a  white  woman  recently 
apprehended  as  a  leper,  and  now,  and  probably  for  the  remainder  of  her 
life,  at  Molokai.  This  woman  was  the  daughter  of  a  former  minister  of 
foreign  affairs  under  King  Kalakaua.  She  had  been  a  leper  since  she  was 
five  years  of  age,  had  been  taken  to  Japan,  but  later  on  had  been  returned  to 
her  mother's  home,  where  she  lived  and  was  cared  for  until  her  mother's 
death,  when  she  was  apprehended  by  the  authorities  and  deported  in 
accordance  with  the  law.  Such  cases  occur  every  now  and  then  in  Hawaii, 
clearly  illustrating  that  the  danger  of  disease  transmission  is  not  limited  to 
the  lower  class  native  element  or  to  the  foreign-born. 

Cases  of  Leprosy  in  the  United  States  Reported  Since  1916 
Location  and  Date  Reported  Remarks 

Baltimore,  Md.,  April  13,  1916.  Dr.  M.  S.  Rosenthal  reported  a  colored  boot- 

black afflicted  with  leprosy  at  Mercy  Hos- 
pital. Included  in  his  report  is  the  state- 
ment that,  "This  case  well  illustrates  the  urgent  need  of  a  national  leprosarium, 
where  these  unfortunates  can  find  a  permanent  refuge  and  the  community  be 
spared  the  presence  of  an  unsightly,  mutilated  and  incurable  human  being 
awaiting  the  final  call." 


New  Orleans,  La.,  April  15, 1916. 
April  29, 1916. 
Lake  End,  La.,  April  — ,  1916. 
Boston,  Mass.,  April  — ,  1916. 

New  York  City,  May  6,  1916. 
.Tune  3,  1916. 
Mansfield,  La.,  June  — ,  1916. 
Minneapolis,  Minn.,  June  — ,  1916. 


rous  symptoms  began  during 
explosion  in  1911.  No  history 

San  Francisco,  Calif.,  July  15,  1916. 


July  15,  1916. 
Los  Angeles,  Calif.,  July  15,  1916. 
White  Fish,  Mont.,  July  — ,  1916. 
Boston,  Mass.,  Aug.  11, 1916. 
Bellingham,  Wash.,  Aug.  19,  1916. 

New  Orleans,  La.,  Aug.  19,  1916. 
Yokohama,  Japan,  Aug.  22,  1916. 

Galveston,  Texas,  Aug.  26,  1916. 
Los  Angeles,  Calif.,  Aug.  26,  1916. 
San  Francisco,  Calif.,  Sept.  2,  1916. 
Sept.  30, 1916. 
New  Orleans,  La.,  Sept.  30,  1916. 
Oct.  7,  1916. 
Seattle,  Wash.,  Oct.  7,  1916. 


One  case. 

Negro  woman. 

Native  of  Harput,  Turkey.  Sent  to  Penikese 

Island. 

One  case;  one  death. 

One  death. 

Colored  male. 

Chinese,  native  of  Otage,  Japan,  in  United 

States  nine  years.    Lived  in  Montana  until  he 

came  to  Minneapolis,  March  7,  1916.  Lep- 
convalescence  from  severe  burn  due  to  gasolene 
of  leprosy  in  patient's  family. 

American,  had  come  from  Denver  four  years 
previously.   Left  for  Louisville,  Ky.,  June  7, 
1916. 
One  case. 

Chinese. 

Cuban  student,  removed  to  Penikese  Island. 

A  Greek  who  had  been  in  the  United  States 

more  than  three  years. 

Two  cases  reported. 

Twenty-five  cases  of  Americans  ivith  leprosy 

reported  in  different  parts  of  Japan. 

One  case. 


Two  cases. 
One  case. 


22 


Location  and  Date  Reported  Remarks 

New  Orleans,  La.,  Oct.  14,  1916.  One  case. 

Milwaukee,  Wis.,  Nov.  2,  1916.  Greek. 

Los  Angeles,  Calif.,  Nov.  11,  1916.  One  case. 

New  Haven,  Conn.,  Nov.  20,  .1916.  Case  reported  by  Dr.  John  E.  Lane,  con- 

firmed by  Dr.  C.  J.  Bartlett,  of  the  Yale  Uni- 
versity Medical  School.  It  is  said  in  this 
connection  that:  "The  chief  interest  in  this  case  is  the  illustration  of  the  fact 
that  leprosy  patients  wander  about  for  a  long  time  without  being  recognized,  as 
a  majority  of  the  physicians  have  never  seen  a  case  of  the  disease,  and  quite 
naturally  do  not  suspect  it." 


New  Orleans,  La.,  Nov.  25,  1916. 
New  York  City,  Nov.  25,  1916. 
Newark,  N.  J.,  Dec.  2,  1916. 
New  York  City,  Dec.  2,  1916. 
Ansonia,  Conn.,  Dec.  9,  1916. 


Indianapolis,  Ind.,  Dec.  10,  1916. 


San  Francisco,  Calif.,  Dec.  12,  1916. 
Dec.  16,  1916. 
Fort  Branch,  Ind.,  Dec.  21,  1916. 

Williamsport,  Pa.,  Dec.  30,  1916. 
Oakland,  Calif.,  Dec.  — ,  1916. 
New  Orleans,  La.,  Dec.  — ,  1916. 
San  Francisco,  Calif.,  Jan.  13,  1917. 
Jan.  20, 1917. 
New  York  City,  Feb.  3,  1917. 
Jersey  Citv,  N.  J.,  Feb.  10,  1917. 
New  Orleans,  La.,  Feb.  10,  1917. 
Los  Angeles,  Calif.,  Feb.  10,  1917. 
New  Orleans,  La.,  Feb.  17,  1917. 
San  Diego,  Calif.,  Feb.  17,  1917. 

Milwaukee,  Wis.,  Feb.  21,  1917. 

San  Francisco,  Calif.,  Feb.  24,  1917. 

Jersey  City,  N.  J.,  Feb.  — ,  1917. 

New  Orleans,  La.,  (Parish)  Feb.  — ,  1917. 

March  3,  1917. 
New  York  City,  March  17,  1917. 
San  Francisco,  Calif.,  March  24,  1917. 
Springfield,  Mass.,  May  10, 1917. 


Richmond,  Contra  Costa  Co.,  Calif.,  May 

14,  1917. 
Oakland,  Calif.,  May  17,  1917. 
Los  Angeles,  Calif.,  May  26,  1917. 
New  Orleans,  La.,  May  26,  1917. 
New  York  City,  May  26,  1917. 
Los  Angeles,  Calif.,  June  9,  1917. 
Klamath  Falls,  Ore.,  June  14,  1917. 
New  York  City,  June  16,  1917. 
Burtville,  E.   Baton  Rouge  Parish,   La., 

June  — ,  1917. 
Los  Angeles,  Calif.,  July  13,  1917. 


Collaborating  Epidemi- 
the    Connecticut    State 


One  case. 
Two  cases. 
Syrian. 
One  case. 
Case   reported   by 
ologist    Black,    of 
Board  of  Health. 

Naval  veteran  of  the  Civil  War.   Case  diag- 
nosed by  a  young  interne — Dr.  C.  V.  Kemp 
— at  Long  Hospital,  who  had  never  previ- 
ously seen  leprosy. 
One  case. 

Native  of  Indiana,  but  formerly  lived  in 
Alaska,  Mexico,  and  Panama  Canal  Zone. 
One  case. 
Three  cases. 
Two  cases. 
One  case. 


Mexican,  transferred  to  Los  Angeles  County 

Hospital. 

One  case. 


Three  cases  notified  during  the  month. 


One  case. 


Syrian,  who  had  escaped  from  City  Hos- 
pital, Newark,  N.  J.,  largely  because  of  in- 
adequate precautions  and  otherwise  un- 
suitable surroundings. 

One  case. 

Chinese  case. 

Mexican. 

Two  cases. 

One  case. 

Hawaiian  case. 

Italian,  formerly  living  in  Spokane. 

One  case. 

Negro. 

Japanese  woman,  resident  for  about  one  year. 


23 


Location  and  Date  Reported  Remarks 

Phillipsburg,  N.  J.,  July  17,  1917.  Two  cases,  originally  discovered  on  Black- 

well's  Island,  N.  Y.    Children  of  a  woman, 
also  a  leper,  whose  cause  of  death  had  been 
certified  as  embolism,  although  the  symptoms  were  similar  to  those  of  the  dis- 
ease in  the  children.    (See  also  Newark  Evening  News,  April  12,  1918.) 


Los  Angeles,  Calif.,  July  21,  1917. 
New  York  City,  July  26,  1917. 
Syracuse,  N.  Y.,  Aug.  17,  1917. 


White  Pine  County,  Nev.,  Aug.  17,  1917. 
Garyville,  St.  John  Parish,  La.,  Aug.  — ,  1917. 


Providence,  R.  I.,  Sept.  14,  1917. 

New  Orleans,  La.,  Sept.  29,  1917. 
San  Francisco,  Calif.,  Oct.  13,  1917. 
Biloxi,  Miss.,  Oct.  18,  1917. 


Alberton,  Mont.,  Oct.  19,  1917. 
San  Francisco,  Calif.,  Oct.  27,  1917. 
Nov.  10,  1917. 
New  Orleans,  La.,  Nov.  17,  1917. 
Williamsport,  Pa.,  Nov.  19,  1917. 

Galveston,  Texas,  Dec.  1,  1917. 
Bennettsville,  S.  C,  Dec.  15,  1917. 
Long  Beach,  Miss.,  Dec.  — ,  1917. 
Jersey  City,  N.  J.,  Jan.  30,  1918. 

Portland,  Ore.,  Feb.  9,  1918. 
New  Orleans,  La.,  Feb.  16,  1918. 
Feb.  23,  1918. 
Jersey  City,  N.  J.,  Feb.  25,  1918. 


One  case. 

Greek,  who  came  to  United  States  in  1913. 
Two  cases  reported,  brothers,  natives  of 
Greece,  formerly  residents  of  New  York 
City.  (One  of  these  escaped  August  15,  be- 
cause of  inadequate  precautions.) 
One  case. 

Father  and  three  brothers  of  this  patient  had 
previously  been  sent  to  the  State  Lepers 
Home. 

Native  of  Italy,  resident  of  this  country  five 
years. 
One  case. 

This  man  was  employed  as  oyster  shucker 
when  discovered,  having  followed  that  occu- 
pation for  past  six  years. 
One  case. 


Sicilian,    in    United    States    eleven    years. 
Isolated  outside  of  city. 
One  case. 

Native  and  former  resident  of  Louisiana. 
Native  of  Germany,  formerly  a  resident  of 
Brooklyn,  who  died  by  suicide  day  following. 
One  case. 


Negro  woman  from  West  Indies.  This  was 
the  third  case  for  some  time  past  reported  to 
local  authorities,  one  having  been  a  Mexi- 


can, and  second  case,  also  apparently  a  foreigner,  who  committed  suicide. 


West  Haven,  Conn.,  Feb.  — ,  1918. 
Galveston,  Texas,  March  2,  1918. 
Oakland,  Calif.,  March  2,  1918. 
New  Orleans,  La.,  March  9,  1918. 

March  13,  1918. 

March  23,  1918. 
Los  Angeles,  Calif.,  March  23,  1918. 
San  Francisco,  Calif.,  March  23,  1918. 
Los  Angeles,  Calif.,  April  9,  1918. 
April  13,  1918. 
San  Francisco,  Calif.,  April  20,  1918. 
Riverside,  Calif.,  April  23,  1918. 
Louisville,  Ky.,  April  27,  1918. 
Philadelphia,  Pa.,  April  29,  1918. 
Boston,  Mass.,  May  7,  1918. 
New  Orleans,  La.,  May  25,  1918. 
Rio  Vista,  Calif.,  May  — ,  1918. 


One  case. 


One  death. 

Native  East  Indian. 

One  case. 

Native    Hawaiian,    age 

the  islands  3^  years. 


14;    had   lived    in 


24 


Location  and  Date  Reported 
Fresno,  Calif.,  May  — ,  1918. 

San  Francisco,  Calif.,  May  — ,  1918. 

Abilene,  Texas,  June  8,  1918. 
Bridgeport,  Conn.,  June  8,  1918. 
New  Orleans,  La.,  June  8,  1918. 
June  29,  1918. 
Alexandria,  La.,  June  29,  1918. 
Boston,  Mass.,  June  29,  1918. 
June  — ,  1918. 

Bridgeport,  Conn.,  June  — ,  1918. 

Avoyelles  Parish,  La.,  June  - — ,  1918. 

Oakland,  Calif.,  July  13,  1918. 
July  27, 1918. 
Mandeville,  La.,  July  — ,  1918. 
New  Orleans,  La.,  July  — ,  1918. 
Oakland,  Calif.,  July  — ,  1918. 


Boston,  Mass.,  July  — ,  1918. 

New  Orleans,  La.,  Sept.  21,  1918. 
Sept.  28,  1918. 
Dayton,  Ohio,  Sept.  — ,  1918. 
Tyron,  N.  C,  Sept.  — ,  1918. 

Boston,  Mass.,  Oct.  29,  1918. 
Glendale,  Ariz.,  Oct.  — ,  1918. 
Boston,  Mass.,  Nov.  2,  1918. 
Galveston,  Texas,  Nov.  2,  1918.. 
New  York  City,  Nov.  9,  1918. 
New  Orleans,  La.,  Nov.  13,  1918. 
Nov.  16,  1918. 
Los  Angeles,  Calif.,  Dec.  21,  1918. 
Feb.  2,  1919. 
Braddock,  Pa.,  Feb.  — ,  1919. 
New  Orleans,  La.,  March  8,  1919. 
San  Francisco,  Calif.,  March  8,  1919. 
Philadelphia,  Pa.,  March  15,  1919. 
District  of  Columbia,  March  — ,  1919. 

Galveston,  Texas,  April  19,  1919. 

Philadelphia,  Pa.,  April  21,  1919. 


New  Orleans,  La.,  April  26,  1919. 
San  Francisco,  Calif.,  April  26,  1919. 
April  — ,  1919. 


Remarks 
Two  cases;  one  a  native  woman  of  Mexico, 
and  one  a  Chinaman,  of  Louisiana. 
Chinaman,  resident  in  United  States  eight 
years. 
One  case. 


Two  cases.  One  a  native  of  China,  and  one 

a  Russian. 

Greek,  resident  of  United  States  for  past 

four  years. 

One  case.    Transferred  to  Louisiana  State 

Leper  Colony. 

One  case. 

Two  cases. 

One  case. 

Two  cases.  Chinamen;  natives  of  Hawaii, 
possibly  previously  reported  from  other  lo- 
calities. 

Two  cases.   One  from  nearby  state,  sent  to 
Penikese  Island. 
One  case. 
Two  cases. 

Greek,  formerly  resident  of  Columbus,  Ohio. 
Famous  Early  case.  Early  had  escaped  from 
Washington,  D.  C. 
Native  of  Cape  Verde  Islands. 
Native  Mexican. 
One  case. 

One  death. 
One  case. 


Native  of  Philippine  Islands. 
One  case. 

One  case.  Patient  died  of  smallpox,  March 
22,  1919. 

White  woman,  life-long  resident  of  Galves- 
ton. 

Syrian,  reported  as  having  disappeared, 
probably  with  intention  to  reach  New  York. 
Peddler,  apparently  same  case  as  reported 
from  Springfield,  Mass.,  and  Newark,  N.  J. 
One  case.  Died. 


Native  Californian  who  had  never  been  out- 
side the   State,   being   one  of  three  cases 
known   to   have   been    contracted,   without 
question,  in  California.  Case  reported  by  Dr.  Howard  Morrow,  of  San  Francisco. 
Stockton,  Calif.,  April  — ,  1919.  Native  of  Stockton,  whose  brother  is  sus- 

pected of  being  a  leper,  and  whose  father 
had  leprosy  at  the  time  of  his  death  in  1912. 


25 


Location  and  Date  Reported 
Hartford,  Conn.,  April  — ,  1919. 

New  Orleans,  La.,  May  3,  1919. 
New  York  City,  May  3,  1919. 
Philadelphia,  Pa.,  May  3,  1919. 
Portland,  Ore.,  May  3,  1919. 
Monte  Rio,  Calif.,  May  4,  1919. 
San  Francisco,  Calif.,  May  8,  1919. 
Boston,  Mass.,  May  10,  1919. 
New  York  City,  May  10,  1919. 
San  Francisco,  Calif.,  May  10,  1919. 
Boston,  Mass.,  May  24,  1919. 
San  Francisco,  Calif.,  May  — ,  1919. 
El  Centro,  Calif.,  May  — ,  1919. 
San  Francisto,  Calif.,  June  7,  1919. 
Los  Angeles,  Calif.,  June  10,  1919. 
June  14,  1919. 
Baltimore,  Md.,  June  14,  1919. 
New  Orleans,  La.,  June  21,  1919. 
Philadelphia,  Pa.,  June  21,  1919. 
Orleans  Parish,  La.,  June  — ,  1919. 
St.  Martin  Parish,  La.,  June  — ,  1919. 
Contra  Costa  County,  Calif.,  June  — ,  1919, 
New  Orleans,  La.,  July  12,  1919. 
Boston,  Mass.,  July  14,  1919. 

San  Francisco,  Cailf.,  July  26,  1919. 
July  — ,  1919. 
Santa  Rosa,  Calif.,  July  — ,  1919. 
LaFayette,  La.,  July  — ,  1919. 
Olympia,  Wash.,  July  — ,  1919. 
New  Orleans,  La.,  Aug.  2,  1919. 
Sacramento,  Calif.,  Aug.  16,  1919. 
San  Francisco,  Calif.,  Aug.  16, 1919. 
Lansing,  Mich.,  Aug.  30,  1919. 

New  York  City,  Aug.  — ,  1919. 
Galveston,  Texas,  Aug.  30,  1919. 
Otero  County,  Colo.,  Aug.  — ,  1919. 
Beloit,  Wis.,  Sept.  6,  1919. 
Benton  Harbor,  Mich.,  Sept.  6,  1919. 
Los  Angeles,  Calif.,  Sept.  6,  1919. 
New  York  City,  Sept.  13,  1919. 
New  Orleans,  La.,  Sept.  13,  1919. 
Los  Angeles,  Calif.,  Sept.  27,  1919. 
San  Francisco,  Calif.,  Sept.  27,  1919. 
Oct.  4,  1919. 
Los  Angeles,  Calif.,  Oct.  11,  1919. 
Houston,  Texas,  Oct.  18,  1919. 
Boston,  Mass.,  Nov.  1,  1919. 
Los  Angeles,  Calif.,  Nov.  1,  1919. 
New  York  City,  Nov.  1,  1919. 
Pueblo,  Colo.,  Nov.  1,  1919. 
New  Orleans,  La.,  Nov.  8,  1919. 
San  Francisco,  Calif.,  Nov.  8,  1919. 
Ann  Arbor,  Mich.,  Nov.  13,  1919. 
Los  Angeles,  Calif.,  Nov.  22,  1919. 
New  Orleans,  La.,  Nov.  22,  1919. 
Charlotte,  N.  C,  Nov.  29,  1919. 


Remarks 
Native  of  Trinidad,  West  Indies,  formerly 
resident  of  Providence  and  Boston. 
One  case. 


Chinaman,  born  in  San  Francisco. 

Mexican. 

One  case. 

Two  cases  and  one  death. 

One  case. 


(Patient  escaped  to  Mexico.) 


One  case. 
One  case. 
Mexican. 
One  death. 

One  case. 
One  death. 
Two  cases. 
One  case. 


Case  reported  of  a  leper  who  escaped  from 
the  Detention  Hospital,  subsequently  appre- 
hended in  Philadelphia. 
One  case. 
Mexican  male. 

Formerly  resident  of  Hawaii. 
One  case. 


One  case.  Formerly  U.  S.  soldier  who  had 
been  in  service  in  Philippines. 
One  case. 


One  death. 

One  case. 

Native  of  Porto  Rico. 

One  case. 

One  case;  one  death. 

One  case. 

Two  cases. 
One  case. 


One  death. 
One  case. 

One  death. 

One  case. 
Two  cases. 
One  case. 


26 


Location  and  Date  Reported  Remarks 

St.  Joseph,  Mo.,  Nov.  29,  1919.  One  case.  ,     r^     r^ 

Cambridge,  Wis.,  Nov.  — ,  1919.  Second  case  reported  in  State,  by  Ur.  Cor- 

nelius A.  Harper,  of  Madison. 
Chicago,  111.,  Nov.  — ,  1919.  One  case. 

Pinos  Altos,  N.  M.,  Nov.  — ,  1919. 
La  Junta,  Colo.,  Dec.  6,  1919.  Mexican. 

Galveston,  Texas,  Dec.  6,  1919.  One  death.  ,       .        x 

Ann  Arbor,  Mich.,  Dec.  13,  1919.  One  case.    (Possibly  previously  given.) 

Christiana  Wis.,  Dec.  — ,  1919.  One  death.    (Originally  diagnosed  June  3, 

1919.) 
Boston,  Mass.,  Jan.  22,  1920.  One  case,  formerly  of  Rome,  N.  Y.   Worker 

in  chocolate  factory. 
Tilden,  Neb.,  Jan.  29,  1920.  Spanish  War  veteran. 

Boston,  Mass.,  Jan.  31,  1920.  Second  case  reported  withm  fortnight;  ce- 

ment worker  from  Baltimore ;  sent  to  i  eni- 
kese  Island. 
San  Francisco,  Calif.,  Jan.  31,  1920.  One  case.  ,      ^,      ,      ,    ^      . 

Dayton,  Ohio,  Feb.  29,  1920.  According  to  the  Cleveland  Leader,  case 

being   cared  for  at  present   time   at   Day- 
ton.   A  Greek,  whom  it  is  proposed  to  re- 
turn to  his  native  country.   Stated  in  same  dispatch  that  there  had  been  a  leper 
in  same  locality — Mexican— who  had  escaped  several  months  ago. 
New  York  City,  March  7,  1920.  According  to  Bronxborough  Netvs  of  March 

7th  there  are  at  present  time  22  cases  of 
known  leprosy  in  New  York  City,  subject  to 
practically  no  restrictions  or  supervision,  being  allowed  to  walk  about  the  streets 
of  the  city  on  the  assumption  that  "the  disease  can  not  develop  in  this  climate. 
This,  of  course,  is  a  serious  error,  for  leprosy  develops  in  any  climate  and  under 
any  conditions  of  life,  as  far  as  known,  where  there  is  exposure  to  existing  cases, 
or  contact,  since  the  disease  is  known  to  be  transmissible,  although  the  exact 
method  of  transmission  remains  a  mystery.* 
Muskogee,  Okla.,  March  13,  1920.  A  negro  suspect  escaped  from  Coffeyville, 

Kans.,   was    apprehended    by   local    health 
authorities. 
Lansing,  Mich.,  March  26,  1920.  One  case.  Native  of  Lansing. 

New  Orleans,  La.,  April  15,  1920.  Two   cases.    Found  by  city  health  officials 

while  awaiting  "treatment"  at  the  hands  ot 
a  faith  healer. 

Need  and  Value  of  a  National  Leprosy  Conference 
The  preceding  list  of  cases  should  arouse  the  interest  of  an  indifferent 
public,  an  indifferent  medical  profession,  and  a  public  health  service  far 
from  being  as  active  as  the  needs  of  the  present  situation  demand.  Whether 
leprosy  is  actually  on  the  increase  or  not  is  secondary  to  the  question  that 
the  disease  occurs  with  a  sufficient  degree  of  frequency  throughout  prac- 
tically the  whole  United  States  to  demand  a  change  from  public  apathy, 
little  short  of  a  crime.  Other  countries,  in  which  a  much  lesser  number  of 
cases  occur,  make  adequate  provision  and  render  adequate  reports  with  a 
reasonable  assurance  that  measures  of  control  are  more  effective  than  they 
are  apparently  in  this  country  at  the  present  time.  The  example  of  Argen- 
tina may  well  be  followed  in  this  country,  for  only  a  national  conference 
thoroughly  representative  of  all  the  interests  concerned  can  arouse  the 
American  public  to  a  danger  that  confronts  future  generations  if  new 
endemic  centers  are  allowed  to  be  created.    It  is  not  a  problem  for  a 

♦The  actual  number  of  cases  in  New  York  City  at  the  present  time  i«  28. 

27 


city  or  a  State  to  solve,  but  a  matter  of  the  utmost  national  and  interna- 
tional concern.  Much  good  unquestionably  resulted  from  the  international 
leprosy  conferences  of  1897  and  1909,  and  a  similar  conference  called  at 
the  present  time,  even  if  limited  to  the  Pan-American  republics,  would 
unquestionably  prove  productive  of  far-reaching  results.  But  if  such  a 
congress  could  be  made  inclusive  at  least  of  the  countries  of  the  Far  East, 
and  if  held  in  the  United  States,  tlie  best  thought  of  the  present  day  would 
be  concentrated  upon  an  agreement  as  to  the  course  of  procedure  likely 
to  prove  most  advantageous  to  the  patient  and  the  public  directly  concerned. 

I  may  in  this  connection  direct  attention  to  a  remarkable  address 
on  "Leprosy:  A  New  View  of  Its  Bacteriology  and  Treatment,"  by  T.  S. 
Beauchanfp  Williams,  M.D.,  contributed  to  the  Indian  Medical  Gazette 
for  May,  1911,  as  an  illustration  of  much  neglected  phases  of  the  subject 
in  this  country.  At  the  same  time,  I  may  recall  an  excellent  outline  of 
fundamental  principles,  by  Dr.  Isadore  Dyer,  set  forth  in  an  address  on 
"The  Dermatologic  Aspects  of  Leprosy,"  contributed  to  the  proceed- 
ings of  the  Sixty-fourth  Annual  Session  of  the  American  Medical  Asso- 
ciation in  1913.  Two  years  later  Dr.  Douglass  W.  Montgomery  read  an 
important  address  on  "Illustrations  of  the  History  of  Leprosy,"  in  the  sec- 
tion on  dermatology,  of  the  American  Medical  Association,  San  Francisco, 
1915,  and  many  of  those  present  were  given  the  privilege  of  observing 
actual  cases  of  leprosy,  brought  down  to  the  meeting  from  the  Isolation 
Hospital  of  the  city.  The  paper  by  Dr.  Montgomery  was  increased  in  value 
by  a  report  of  cases  with  observations  on  "Symptoms  and  Diagnosis  of 
Leprosy,"  by  Dr.  Howard  Morrow  and  Dr.  A.  W.  Lee,  of  San  Francisco, 
clearly  illustrating  that  in  its  scientific  aspects  the  disease  is  not  being 
neglected  in  this  country.  Nor  must  I  omit  to  refer  by  title  to  an  address 
on  "The  Etiology  and  Treatment  of  Leprosy,"  by  Dr.  Ernest  Dwight  Chip- 
man,  read  at  the  same  meeting,  which  will  always  represent  a  milestone 
in  the  progress  of  the  study  of  a  subject  which,  on  account  of  the  rarity 
of  the  disease,  is  perhaps  one  of  the  most  diflfiicult  problems  of  modern 
medicine. 

Medical  and  Dermatological  Aspects  of  Leprosy 

Regardless  of  the  advances  which  have  been  made  during  recent  years, 
we  are  still  far  behind  in  the  adequate  consideration  of  questions  of 
etiology,  diagnosis,  and  treatment  based  upon  the  actual  experience  which 
has  been  had  in  this  coimtry  and  which  unquestionably,  in  important  mat- 
ters of  detail,  differs  from  the  experience  in  large  endemic  leprosy  centers 
abroad.  This  point  of  view  is  perhaps  best  illustrated  by  reference  to  the 
extremely  interesting  report  on  the  treatment  of  leprosy,  by  Dr.  F.  Hall, 
superintendent  of  the  leper  asylum  at  Makogai,  Fiji  Islands,  and  the 
admirable  statistical  analysis  of  10,000  cases  of  leprosy  at  the  Culion 
Leper  Colony,  Philippine  Islands,  by  Dr.  Oswald  E.  Denney.  This  paper 
is  of  special  interest  if  read  in  connection  with  the  observations  on  the 
treatment  of  leprosy  in  the  Philippine  Islands,  by  Dr.  Victor  G.  Heiser, 

28 


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formerly  the  director  of  health  and  a  surgeon  of  the  United  States  Public 
Health  Service  (1914).  The  scientific  study  of  the  subject  would  be  very 
much  enhanced  if  more  detailed  reports  were  made  of  the  cases  under 
observation  throughout  the  country,  but  particularly  in  the  larger  centers 
like  Louisiana,  Massachusetts,  California,  and  Molokai.  The  best  illustra- 
tions of  the  proper  method  of  reporting  on  existing  cases  are  the  annual 
reports  on  leprosy  in  New  South  Wales,  including  an  annual  review 
with  observations  of  all  cases  at  the  colony  at  Little  Bay  since  1883.  Such 
a  tabular  analysis  for  Hawaii  would  make  an  extremely  interesting  con- 
tribution to  knowledge  and  possibly  aid  in  the  solution  of  a  problem  which 
thus  far  has  failed  to  meet  the  exacting  requirements  of  modern  scientific 
research.  iThe  New  South  Wales  reports  give  tlie  name  (by  initials),  the 
sex,  nativity,  occupation,  date  of,  and  age  on  admission,  locality  where 
disease  was  probably  contracted,  number  of  the  case,  clinical  notes,  and 
the  date  of  death  or  discharge.  The  clinical  notes  describe  in  detail, 
though  with  the  required  brevity,  the  history  of  the  illness,  the  conditions 
on  admission,  differentiating  the  parts  of  the  body,  and  finally,  notes  on 
the  progress  of  the  disease  and  the  treatment,  presenting  in  brief  a  rea- 
sonably complete  picture  of  the  cases  under  treatment,  amplified  by  notes 
on  the  examinations  of  material  for  leprosy  bacilli  carried  out  by  the 
microbiological  laboratory  of  the  department  of  public  health. 

Present  Status  of  the  Federal  Leprosarium 
It  would  be  utterly  impossible  to  attempt,  within  the  necessary  limita- 
tions of  time,  the  presentation  of  the  essential  facts  of  leprosy  occurrence 
throughout  the  world,  although  an  abundant  amount  of  extremely  valuable 
material  is  available  for  the  purpose.  The  hope  that  the  leprosy  investi- 
gations at  the  United  States  station  at  Molokai  would  very  materially 
increase  our  knowledge  of  the  disease  from  its  incipient  to  its  advanced 
stage  has  not  been  realized.  But  even  more  lamentable  is  the  long  delay 
in  the  establishment  of  a  federal  leprosarimn  in  accordance  with  the  act 
of  Congress  of  February  3,  1917,  although  it  may  be  said  that  the  outlook 
at  the  present  time  is  somewhat  more  hopeful  that  such  an  institution  will 
shortly  be  established,  though  possibly  not  in  a  locality  entirely  suitable 
for  the  purpose. 

I  am  able  to  conclude  this  address  with  a  letter  from  the  Acting  Sur- 
geon General  of  the  United  States  Public  Health  Service,  dated  March  10, 
1920,  who  in  answer  to  an  inquiry  as  to  the  present  status  of  the  leprosarimn 
question,  replied  as  follows: 

"In  reply  to  your  letter  oi  March  Sth  requesting  information  as  to  the  present 
status  of  the  Federal  Home  for  Lepers,  I  have  the  honor  to  inform  you  that  the  Board 
hopes  to  begin  construction  within  a  short  time.  As  you  know,  the  Surgeon  General 
appointed  a  Board  of  which  you  were  a  member  to  assist  in  the  selection  of  a  site. 
TTiis  Board  made  a  careful  and  comprehensive  survey  of  all  available  sites  in  all 
sections  of  the  United  States  and  decided  that  the  best  and  most  suitable  site  for  the 
Federal  Leprosarium  would  be  on  the  three  islands  known  as  Snake  Key,  North  Key 
and  Sea  Horse  Key,  lying  in  the  Gulf  of  Mexico  off  Cedar  Keys,  Florida.   The  Board 

30 


80  recommended  to  the  Surgeon  General  who  approved  their  findings  and  forwarded 
them  to  the  Secretary  of  the  Treasury  with  a  request  that  the  transfer  of  these  three 
islands  be  requested  from  the  Department  having  jurisdiction.  In  accordance  with 
the  request  of  the  Secretary  of  the  Treasury  the  Secretary  of  War  on  September  5th 
transferred  Snake  Key  and  North  Kev  for  the  purposes  of  a  leprosarium  disclaiming 
jurisdiction  of  Sea  Horse  Key  ^vhich  had  been  set  apart  for  light  house  purposes  on 
September  25,  1851,  and  was  therefore  under  the  jurisdiction  of  the  Department  of 
Commerce.  A  Department  letter  addressed  to  the  Secretary  of  Commerce  asking  for 
permission  to  use  and  occupv  Sea  Horse  Key  for  the  proposed  Federal  Home  for 
Lepers  was  favorably  answered  by  the  Secretary  of  Commerce  on  September  19,  1919 

"As  might  be  expected  the  selection  of  a  site  for  a  leprosarium  in  any  state  would 
develop  some  opposition.  The  entire  Florida  delegation  accompanied  the  Governor 
of  Florida  in  a  \isit  of  protest  to  the  Surgeon  General  on  October  23rd,  1919.  The 
opposition  locally,  however,  is  largely  the  development  due  to  the  activity  of  one  man, 
and  through  a  very  active  propaganda  instituted  by  him  throughout  the  state. 

"Since  that  time  Government  representatives  have  been  able  to  present  the  facts 
to  the  people  of  Florida  and  a  very  strong  sentiment  has  developed  for  the  establish- 
ment of  the  leprosarium  on  the  site  named  above.  _     _ 

"Owing  to  the  popular  fallacy  concerning  the  danger  of  leprosy  it  is  not  to  be 
expected  that  less  opposition  will  he  encountered  in  any  state  and  in  all  probabilities 
the  Department  will  go  ahead  -^vith  the  construction  of  the  Federal  ^Home  for  Lepers 
upon  the  three  keys  named  in  the  vicinity  of  Cedar  Keys,  Florida." 

Importance  of  Accurate  and  Complete  Leprosy  Statistics 
The  question  of  leprosy  increase  and  the  adequate  federal  care  and 
proper  treatment  of  lepers  is,  therefore,  one  of  the  near  future,  being 
largely  dependent  upon  an  aroused  public,  professional  and  governmental 
interest.    Leprosy  at  the  present  time  may  possibly  have  reached  a  more 
or  less  stationary  condition  in  this  country,  but  it  is  not  to  the  credit  of 
our  civilization  that  the  frequency  of  the  disease  should  not  be  actually 
on  the  decrease.  The  apparent  increase  can  not  be  charged  exclusively  to  the 
foreign  element,  which  can  not  if  leprous  be  kept  out  by  even  the  most  rigid 
quarantine  examination,  but,  as  shown  by  the  experience  in  Louisiana, 
for  at  least  one  hundred  years,  the  disease  has  gradually  been  gaining  in 
frequency  until  a  number  of  endemic  centers  now  exist  as  to  which  the 
public  at  large  is  rightfully  entitled  to  more  trustworthy  information  than 
is  at  present  available.    According  to  the  reports  received  from  health 
officials  all  over  the  country,  there  are  at  present  not  less  than  eighty-seven 
cases  in  Louisiana,  thirty-nine  cases  in  California,  thirteen  cases  at  the 
Penikese  Colony  of  the  State  of  Massachusetts,  twenty-eight  cases  in  the 
city  of  New  York,  five  cases  in  Connecticut,  ten  cases  in  Minnesota,  and 
thirty-three  cases  in  Texas.   There  are  sufficient  reasons  for  believing  that 
the  number  of  known  cases  probably  represents  less  than  one-half  of  the 
actual  number  of  cases  in  this  country  at  the  present  time,  and,  restating 
the  estimate  previously  arrived  at,  which  unquestionably  falls  short  of  the 
whole  truth,  the  probable  number  of  cases  of  leprosy  in  this  country  at 
the  present  time  is  not  less  than  400.    The  situation  is  therefore  a  most 
serious  one,  which  it  is  the  duty  of  the  Government  to  consider  with  a 
lesser  degree  of  indifference  than  has  been  the  case  in  the  past,  and  more 
so  in  view  of  the  liberality  of  Congress  in  providing  adequately  for  the 
establishment  of  one  federal  leprosarium,  which  it  is  hoped  will  in  time 

31 


be  followed  by  two  or  three  others,  as  the  only  hope  of  dealing  effectively 
with  the  question  of  proper  segregation  and  control.  It  is  the  firm  belief 
of  those  who  are  best  in  a  position  to  judge,  that  only  by  means  of  such 
segregation  can  the  frequency  of  the  disease  be  reduced — at  least  this  has 
been  the  experience  at  Tracadie  in  New  Brunswick,  at  Bergen  in  Norway, 
and  at  Molokai  in  Hawaii.  Nothing  could  be  more  wrongful  than  to  arouse 
an  unnecessary  alarm  on  the  part  of  the  general  public,  for  the  actual 
danger  of  an  extensive  spread  of  the  disease  is  slight,  but  whoever  has  seen 
even  one  case  of  leprosy,  and  I  personally  have  seen  more  than  two  thou- 
sand, can  not  but  feel  a  sense  of  profound  personal  obligation  that  noth- 
ing should  be  left  undone  so  that  this  most  unfortunate  element  of  our 
population  may  be  better  cared  for  in  a  medical  as  well  as  in  a  humane 
sense,  than  is  the  case,  unhappily,  at  the  present  time. 

Summary  of  Conclusions 

On  the  basis  of  the  best  possible  information  it  may  therefore  be  con- 
servatively estimated  that  there  are  not  less  than  250  known  cases,  and 
probably  from  400  to  500  known  and  suspected  cases  of  leprosy  throughout 
the  continental  United  States  at  the  present  time. 

This  estimate  is  more  conservative  than  earlier  assimiptions,  but  the 
available  evidence  would  seem  to  justify  the  conclusion  that  the  disease  is 
very  slowly  increasing  in  this  country  and  that  new  foci  of  leprosy  are 
being  formed  and  as  such  constitute  a  serious  menace  to  the  public  health 
interests  of  the  nation  as  large. 

Under  date  of  February  3,  1917,  or  more  than  three  years  ago,  Con- 
gress enacted  a  bill  providing  the  sum  of  $250,000  for  a  federal  lepro- 
sarium, chiefly  for  the  care  of  interstate  and  international  lepers.  It  is 
regrettable  that  there  should  have  been  so  much  delay  in  establishing  a 
model  federal  institution,  but  the  outlook  seems  fairly  hopeful  that  the 
site  selected  at  Cedar  Keys,  Florida,  will  meet  with  public  approval. 
Whether  it  is  the  best  site  that  could  have  been  selected  is  open  to  question. 

It  was  recommended  that  the  Government  use  the  Ship  Island  quaran- 
tine station,  which  has  been  abandoned  for  other  purposes,  and  could  have 
been  utilized  at  very  small  expense  practically  for  the  immediate  accom- 
modation of  isolated  cases  of  leprosy  throughout  the  South.  The  question 
is  pertinent  why  such  a  site,  in  all  respects  admirable  for  the  purpose, 
should  go  to  waste  when  the  situation  is  most  urgent  and  in  fact  in  some 
cases  a  desperate  one. 

The  first  leper  home  in  this  country  was  established  by  the  State  of 
Louisiana  in  1894  near  Carville,  on  the  Yazoo  and  Mississippi  Valley  Rail- 
way, near  a  point  in  Iberville  Parish,  La.,  known  as  Bruns,  about  sixty 
miles  from  New  Orleans.  That  institution  has  about  one  hundred  inmates 
and  is  under  the  medical  supervision  of  Dr.  Ralph  Hopkins,  of  New  Orleans, 
and  a  board,  of  which  Dr.  Isadore  Dyer  is  a  member. 

At  the  Louisiana  institution  about  eighty  per  cent,  of  the  lepers  cared 

32 


for  are  white,  whereas  the  white  population  of  the  State  is  only  fifty-seven 
per  cent.  Whether  this  would  justify  the  conclusion  that  leprosy  is  rela- 
tively more  common  among  the  white  than  among  the  colored  population 
is  somewhat  doubtful,  for  negro  cases  are  probably  more  effectively 
secreted  than  white  cases. 

The  average  age  on  admission  was  thirty-two  years  for  white  males 
and  forty  years  for  colored  males.  For  females  the  average  age  on  admis- 
sion was  thirty-seven  years  for  white  patients  and  thirty-eight  years  for 
colored  patients.  It  would  therefore  seem  fairly  safe  to  conclude  that  the 
average  age  on  admission  is  somewhat  higher  for  colored  lepers  than  for 
white  lepers. 

Of  the  total  number  of  cases  now  under  observation  at  the  Louisiana 
Home,  about  thirty  per  cent,  are  of  the  tubercular  variety,  twenty-four  per 
cent,  of  the  anesthetic  variety,  and  thirty-seven  per  cent,  of  the  anesthetic 
and  tubercular  varieties  combined. 

The  age  period  of  greatest  frequency  on  admission  was  20-29  years. 

The  average  length  of  treatment  previous  to  death  is  from  about  eight 
to  ten  years.  The  duration  varies  with  different  types  of  the  disease,  being 
longest  in  anesthetic  cases  and  shortest  in  tubercular  cases. 

For  most  of  the  elements  of  the  leprosy  problem  the  data  are  only 
gradually  becoming  available.  In  the  report  of  the  Senate  Committee  on 
Public  Health  and  National  Quarantine  is  included  a  large  amount  of 
international  information,  some  of  which  has  been  brought  down  to  date 
for  the  present  purpose  and  is  included  in  Appendix  B  to  this  address. 

Unfortunately  our  information  regarding  leprosy  in  the  States  in 
which  the  disease  is  fairly  cornmon  is  far  from  complete.  According  to 
the  most  trustworthy  recent  returns  the  number  of  known  ca.ses  of  leprosy 
in  Louisiana  is  eighty-seven;  in  California,  thirty -nine;  in  Massachusetts, 
thirteen;  in  Minnesota,  ten;  in  New  York  City,  twenty-eight;  in  the  State 
of  Pennsylvania,  six;  in  Texas,  thirty-three;  while  isolated  cases  are  known 
to  occur  in  probably  ten  to  fifteen  more  States  at  the  present  time. 

In  the  registration  area,  which  now  includes  about  eighty  per  cent,  of 
the  total  population  of  the  United  States,  there  have  occurred  during  the 
last  ten  years  120  deaths  from  leprosy.  The  recorded  mortality  rate  has 
increased  from  0.13  per  million  in  1900  to  0.29  in  1918.  If  the  death 
rate  of  1918  is  taken  as  0.3  per  million,  the  number  of  probable  cases  in 
the  continental  United  States  may  be  conservatively  placed  at  400.  This 
does  not  represent  the  cases  officially  noted  during  the  lifetime  of  all  the 
lepers,  or  effectively  segregated,  or  subject  to  government  supervision  and 
control,  but  rather  the  assumed  number  of  cases  which  give  rise  to  the 
mortality  indicated  on  the  basis  of  the  probable  known  death  rate  of 
lepers  under  segregation,  placed  as  high  as  80  per  1,000  per  annum. 

The  discussion  includes  a  statement  in  detail  of  nearly  250  reported 
cases  of  leprosy  throughout  the  continental  United  States  during  the  period 
April,  1916,  to  April,  1920.  The  list  clearly  emphasizes  the  menace  to 
the  American  nation  of  a  deplorable  attitude  of  public  apathy  and  neglect. 

33 


It  was  the  evidence  presented  to  the  Senate  Committee  on  Public  Health 
and  National  Quarantine  which  resulted  in  the  passage  of  a  bill  providing 
for  a  federal  leprosarium.  One  institution  will  meet  an  emergency  but  will 
only  in  part  aid  in  the  solution  of  the  problem.  Three  institutions  are  cer- 
tainly required,  and  possibly  four;  there  should  be  one  on  the  Gulf  Coast, 
one  on  the  Pacific,  one  on  the  Atlantic,  and  one  in  the  Central  West.  The 
institutions  now  maintained  by  the  State  of  Massachusetts  at  Penikese 
Island,  Buzzard's  Bay,  by  the  State  of  Louisiana,  by  the  City  of  San 
Francisco  at  the  Isolation  Hospital,  and  by  certain  other  commimities  in 
connection  with  public  institutions,  meet  only  the  most  urgent  needs  of  a 
situation  not  far  from  desperate.  It  is  to  be  hoped  that  the  Public  Health 
Service  wilj  more  actively  concern  itself  in  the  future  with  the  provision 
of  the  act  of  Congress,  which,  though  not  mandatory,  is  certainly  equiva- 
lent to  a  request  that  all  unnecessary  delay  should  be  avoided. 

There  is  leprosy  to  the  north  of  us  in  New  Brunswick  and  British 
Columbia;  there  is  leprosy  to  the  south  of  us  in  the  West  Indies  and  Cen- 
tral America,  the  Panama  Canal  Zone,  and  throughout  a  large  portion  of 
South  America;  there  is  leprosy  to  the  east  of  us  in  European  countries 
such  as  Greece,  Bulgaria,  Syria,  Scandinavia,  Northeast  Germany,  Russia, 
Turkey,  etc. ;  and  there  is  leprosy  on  an  immense  scale  to  the  west  of  us  in 
Hawaii,  the  Philippines,  Japan,  and  throughout  the  farther  East.  Only  a 
grossly  indifferent  public  opinion  can  account  for  our  national  apathy 
towards  a  question  which  has  been  a  subject  for  discussion  in  the  medical 
press  and  otherwise  for  over  fifty  years.  There  are  perhaps  one  hundred 
cases  in  the  Panama  Canal  Zone,  there  are  over  six  hundred  cases  in 
Hawaii,  there  are  over  five  thousand  cases  in  the  Philippines,  and  through- 
out the  world  possibly  not  less  than  three  million  cases,  a  potential  menace 
at  least  to  every  other  country  indifferent  to  its  interest  and  in  our  own  case 
from  the  fact  that  leprosy  in  the  United  States  occurs  often  in  isolated  in- 
stances, one  and  all  of  which  can  be  traced  to  some  locality  where  leprosy 
is  known  to  exist. 

It  may  therefore  be  suggested  that  this  question  should  receive  more 
adequate  consideration  in  the  future  and  that  pressure  should  be  brought 
to  bear  upon  the  public  health  authorities,  the  Federal  Government,  and 
the  several  States  to  deal  more  effectively  and  humanely  with  leprosy 
cases  now  known  to  occur.  It  may  further  be  suggested  that  the  time  is 
opportune  for  another  leprosy  conference  in  continuation  of  the  inter- 
national meetings  held  in  Berlin  in  1897  and  in  Bergen,  Norway,  in 
1909,  and  of  the  corresponding  national  conference  held  in  the  Argentine 
Republic  in  1906."'  Such  a  conference  would  bring  together  the  best  thought 
of  the  present  period  in  behalf  of  the  solution  of  a  problem  which  is  an 
indictment  of  our  civilization  and  most  of  all  of  our  indifference  to  the 
humane  interests  and  the  personal  welfare  of  the  most  afflicted  portion  of 
mankind. 

♦For  important  observations  on  previous  leprosy  congresses  see  the  Journal  of  the  American  Medical 
Association,  April  4,  1896,  February  20,  1897,  and  November  13,  1897.  Also  the  report  by  Sir  Arthur 
Newsholme  and  Sir  Malcolm  Morris  at  the  International  Conference  of  1909.  (Parliamentary  paper,  Cd. 
4916,  London,  1909,  P.  S.  King  &  Son,  London.) 

34 


APPENDIX  A 
Leprosy  in  India 

There  is  no  more  fruitful  field  for  the  statistical  study  of  leprosy  than 
the  vast  Indian  Empire,  for  which  admirable  census  reports  have  been 
published  for  a  long  period  of  time.  These  reports  amplify  the  large 
amount  of  useful  information  contained  in  the  report  of  the  Leprosy  Com- 
mission (Calcutta,  1893).  According  to  the  census  of  India  for  1911  (Cal- 
cutta, 1913)  the  proportion  of  lepers  to  population  was  50  males  and  18 
females  per  100,000  of  each  sex.  Of  the  different  provinces  of  India, 
Assam  suffers  most,  then  Burma,  then,  in  order,  Bihar  and  Orissa,  the 
Central  provinces  and  Berar,  Madras,  Bengal,  Bombay,  the  United  pro- 
vinces, the  Punjab,  and  the  Northwest  Frontier  provmces.  In  the  last  two 
provinces  the  proportion  of  lepers  was  17  males  and  8  females  per  100,000 
of  population  of  each  sex.  It  is  observed  in  the  report  referred  to  that 
"the  physical  and  climatic  characteristics  of  the  tracts  where  leprosy  is 
most  prevalent  differ  greatly.  In  some  of  these  tracts  the  climate  is  dry 
and  the  rainfall  light,  while  others  have  a  damp  climate  with  heavy  rain- 
fall. Some  of  them  are  alluvial  river  valleys,  while  others  have  a  laterite 
or  rocky  soil.  Some  are  low-lying,  others  are  slightly  elevated,  and  others 
again  are  in  mountainous  country.  The  races  who  inhabit  these  areas  also 
vary  greatly,  and  they  subsist  on  different  kinds  of  food." 

Throughout  India  the  ratio  of  male  lepers  is  far  in  excess  of  the  cor- 
responding ratio  of  females.  It  is  pointed  out,  however,  that  while  it  is 
possible  that  males  are  more  susceptible  to  the  disease  than  females,  it  is 
very  improbable  that  this  is  the  case  to  the  extent  indicated  by  the  census 
figures.  For  it  is  held  that  "the  great  disproportion  which  they  show  is 
no  doubt  due  largely  to  the  fact  that  the  disease  is  concealed  wherever 
possible,  and  that  women  are  more  successful  than  men  in  evading  the 
inquisitiveness  of  the  enumerators."  As  regards  the  incidence  of  age,  it 
is  stated  that  "imder  the  age  of  10  the  proportion  of  lepers  is  exceedingly 
small,  but  it  soon  begins  to  grow.  There  is  a  considerable  increase  be- 
tween 10  and  20;  and  from  that  age  up  to  50  the  rise  is  uniform  and 
fairly  rapid.  Between  50  and  60  the  proportion  continues  to  increase 
slightly,  and  then  declines.  Bearing  in  mind  the  fact  that  a  leper's  life  is 
a  comparatively  short  one,  it  would  seem  that  the  greatest  liability  to  the 
disease  occurs  between  the  ages  20  and  50." 

The  occurrence  of  leprosy  according  to  caste  is  an  extremely  complex 
problem  which  cannot  be  dealt  with  briefly  on  account  of  the  (to  us)  practi- 
cally meaningless  designations  of  castes  for  which  there  is  no  equivalent  in 
English-speaking  countries.  Those  who  care  to  examine  into  the  subject  from 
this  viewpoint  should  consult  the  handbooks  for  the  Indian  army  describ- 

35 


ing  the  different  principal  castes  in  India,  published  by  the  government 
printing  office,  Calcutta.  It  is  stated  in  the  census  report  for  1911  that 
"the  low  castes  suffer  more  from  leprosy  than  the  high."  This  greater 
liability-,  it  is  explained,  of  the  lower  castes,  "may  be  ascribed  to  their 
povertv,  and  to  the  small,  insanitary,  and  often  dirty,  houses  in  which  they 
live."  But  it  is  pointed  out  in  this  connection,  "it  must  be  remembered 
that  successful  attempts  at  concealment  are  probably  more  frequent  in  the 
case  of  the  higher  castes.  The  proportion  of  Christians  among  lepers  is 
exceptionally  high,  but  this  is  simply  because  most  of  the  asylimas  are 
managed  by  missionary  bodies,  who  make  many  converts  amongst  the 
unfortimate  inmates." 

The  number  of  lepers  throughout  India  has  decreased  from  126,000 
in  1891  to  109.000  in  1911,  a  diminution  equivalent  to  more  than  13  per 
cent.  This  decrease,  it  is  maintained,  is  genuine  and  indicative  of  a  real 
diminution  in  the  prevalence  of  the  disease.  It  is  pointed  out,  however, 
that  this  is  "partly  the  result  of  the  improved  material  condition  of  the 
lower  castes,  amongst  whom  leprosy  is  most  common,  and  of  a  higher 
standard  of  cleanliness." 

The  total  number  of  leper  settlements  or  asylums  in  India,  according 
to  the  census  of  1911,  was  then  73.  But  these  contained  only  some  5,000  in- 
mates, or  not  quite  five  per  cent,  of  the  total  number  of  lepers.  The  report 
concludes  with  the  following  interesting  observation: 

"The  belief  is  growing  that  leprosy  is  communicated  from  one  human  being 
to  another  bj'  some  insect,  and  two  South  African  doctors  have  recently  pub- 
lished papers  implicating  the  bed  bug  (acanthia  lectularia) .  If  this  theory  be 
correct  it  is  ob'sious  that  the  segregation  of  lepers  in  asylums  must  reduce  the 
number  of  foci  of  the  disease,  and  to  that  extent  prevent  it  from  spreading.  It 
is  worthy  of  note  that  in  many  of  the  districts  where  the  disease  was  most 
prevalent  in  1891,  there  has  since  been  a  remarkable  improvement.  Chamba, 
which  in  1891  had  34  lepers  in  everj'  ten  thousand  of  its  population,  now  has 
only  15;  in  Birbhum  the  corresponding  proportion  has  fallen  from  36  to  16,  in 
Banlcura  from  36  to  23.  in  Simla  from  29  to  18,  in  Dehra  Dun  from  20  to  11, 
in  Garhwal  from  17  to  10.  in  Burdwan  from  22  to  14.  and  in  North  Arakan 
from  28  to  20." 

These  general  observations  on  the  occurrence  of  leprosy  throughout 
India  are  enlarged  upon  in  the  separate  census  reports  for  the  several 
provinces. 

Referring  first  to  the  province  of  Assam  (Shillong,  1912),  it  appears 
that  the  local  rate  of  incidence  varies  between  a  minimum  of  less  than  5 
per  100,000  of  population  to  a  maximum  of  from  85  to  90.  The  report 
directs  attention  to  the  marked  decline  in  the  relative  frequency  of  the 
disease,  but  it  is  not  clear  whether  the  decrease  is  equivalent  to  an  actual 
diminution  or  to  an  improvement  in  the  more  correct  diagnosis.  It  is  said, 
for  illustration,  that  the  general  results  of  the  caste  statistics  point  to  the 
conclusion  that  the  high  proportional  figures  for  Assam  are  due  in  a  great 
measure  to  the  confusion  of  leprosy  with  other  corrosive  or  skin  diseases. 
Of  interest  in  this  connection  is  a  statement  that  "once  a  person  is  attacked 

36 


with  leprosy,  his  expectation  of  life  is  considerably  diminished,  the  aver- 
age period  after  the  appearance  of  the  disease  being  from  10  to  18  years." 

The  report  for  Burma  (Rangoon,  1912)  shows  an  increase  in  the 
frequency  of  the  disease,  the  nimiber  of  lepers  in  1911  being  4,842  males 
and  2,196  females,  or,  respectively,  40  and  18  per  100,000  of  population. 
The  author  of  the  report,  Mr.  C.  Morgan  Webb,  directs  attention  to  the 
interesting  fact  that  there  is  an  exceptionally  low  proportion  of  leprosy 
in  the  five  sea-coast  districts,  and  states  that  "this  would  appear  to  effect- 
ively dispose  of  the  theory  of  Dr.  Hutchinson  that  leprosy  is  caused  by  a 
bacillus  introduced  into  the  stomach  by  means  of  badly  cured  fish,  eaten 
in  a  state  of  partial  decomposition  and  not  sufficiently  cooked."  It  is 
explained  in  this  connection  that  "the  comparative  absence  of  leprosy  in 
coast  districts  would  appear  to  be  a  stronger  argument  against  the  theory, 
than  its  presence  in  regions  remote  from  seas  and  rivers.  However  the 
theory  has  not  yet  succeeded  in  receiving  general  acceptance.  Apart  from 
the  comparative  immunity  of  the  coast  districts  from  leprosy  no  rule  for 
its  general  distribution  by  locality  can  be  formulated.  It  cannot  be  said 
to  be  more  prevalent  in  wet  districts  than  in  dry  districts  or  vice  versa, 
nor  does  the  contour  of  the  country  or  the  diversity  of  its  surface  appear 
to  have  any  appreciable  effect  on  the  prevalence  of  this  infirmity." 

In  addition  to  the  foregoing,  however,  the  report  directs  attention  to 
the  high  degree  of  prevalence  of  leprosy  among  the  Inthas,  a  tribe  of  lake 
dwellers  of  Burmese  race,  which  seems  to  support  the  theory  of  Dr.  Hutch- 
inson that  leprosy  is  caused  by  the  consumption  of  badly  cooked  and 
badly  cured  fish.  The  views  of  Sir  Jonathan  Hutchinson  have  been  set 
forth  in  a  treatise  entitled  "On  Leprosy  and  Fish  Eating,"  (London,  1906) 
which  contains  a  number  of  very  suggestive  references  to  Burma  and  the 
Burmese  type  of  leprosy  (p.  350  et  seq.). 

Aside  from  much  other  interesting  information,  the  report  restates  the 
conclusions  of  the  British  and  Colonial  delegates  to  the  International  Con- 
ference on  Leprosy  held  at  Bergen,  Norway,  in  1909,  as  follows: 

"(1)  Leprosy  is  spread  by  direct  and  indirect  contagion  from  persons  suffer- 
ing from  the  disease.  The  possibility  that  indirect  contagion  may  be  efifected  by 
fleas,  bugs,  lice,  the  itch,  etc.,  has  to  be  borne  in  mind.  Leprosy  is  most  preva- 
lent under  conditions  of  personal  and  domestic  uncleanliness  and  overcrowding, 
especially  w^here  there  is  close  and  protracted  association  between  the  leprous 
and  non-leprous. 

"(2)   Leprosy  is  not  due  to  the  eating  of  any  particular  food,  such  as  fish. 

"(3)  There  is  no  evidence  that  leprosy  is  hereditary;  the  occurrence  of 
several  cases  in  a  single  family  is  due  to  contagion. 

"(4)  In  leprosy  an  interval  of  years  may  elapse  between  infection  and  the 
first  recognised  appearance  of  the  disease.  It  is  a  disease  of  long  duration, 
though  some  of  its  symptoms  may  be  quiescent  for  a  considerable  period  and 
then  recur. 

"(5)  The  danger  of  infection  from  leprous  persons  is  greater  when  there  is 
discharge  from  mucous  membranes  or  from  ulcerated  surfaces. 

"(6)   Compxdsory  notification  of  every  case  of  leprosy  should  be  enforced. 

"(7)  The  most  important  administrative  measure  is  to  separate  the  leprous 
from  the  non-leprous  by  segregation  in  settlements  or  asylums. 

37 


"(8)  In  settlements,  home  life  may  be  permitted  under  regulation  by  the 
responsible  authorities. 

"(9)  The  preceding  recommendations,  if  carried  out,  will  provide  the  most 
efficient  means  of  mitigating  the  leper's  suffering  and  of  assisting  in  his  recov- 
ery, and  at  the  same  time  will  produce  a  reduction  and  ultimate  extinction  of 
the  disease."    (pp.  234-5.) 

In  the  provinces  of  Bengal,  Bihar  and  Orissa  leprosy  is  unusually 
prevalent  in  two  well-defined  centers,  which  contaia  some  12,600  enumer- 
ated cases.  The  average  rate  is  as  high  as  160  per  100,000  of  population, 
and  reaches  a  maximum  intensity  in  the  Bankura  district,  with  a  rate  of 
230.  Since  1901  there  has  been  a  general  decline  of  leprosy  throughout 
the  provinces,  or  for  males  from  72  to  62  and  for  females  from  23  to  21 
per  100,0'00  of  population.  The  decrease  is  ia  part  ascribed  to  a  more 
accurate  diagnosis  of  leprosy  and  particularly  to  such  complaints  as  leuco- 
derma  and  secondary  syphilis,  which  are  excluded  from  the  returns.  It, 
however,  is  held  that  there  is  no  question  of  doubt  that  leprosy  is  gradually 
though  slowly,  becoming  less  common. 

Recalling  the  previous  statement  that  a  leper's  life  is  a  comparatively 
short  one,  the  observation  is  of  interest  tliat  "according  to  one  of  the  most 
reliable  estimates,  tlie  average  duration  of  life  from  the  date  of  attack  is 
only  nine  and  one-half  years  for  tuberculated  and  eighteen  and  one-half 
years  for  anesthetic  leprosy." 

Reference  is  made  to  the  Lepers'  act  of  1898,  applicable  to  the  whole  of 
India,  which  provides  for  the  establishment  of  asylums  to  which  lepers  may 
be  sent  from  specified  areas  and  for  the  arrest  of  pauper  lepers  found 
wandering  in  such  areas,  and  for  their  detention  in  an  asylum.  It  also 
empowers  the  local  government  to  prohibit  lepers  from  engaging  in  cer- 
tain trades  or  occupations  likely  to  endanger  the  public  health. 

Referring  to  the  views  of  Sir  Jonathan  Hutchinson,  as  regards  causa- 
tion of  leprosy  among  fish  eating  races,  it  is  pointed  out  in  the  report  that: 

"Mr.  Hutchinson's  theory  is  not  confirmed  by  the  results  of  the  census  over 
the  areas  where  leprosy  is  most  prevalent.  In  Bankura,  in  particular,  which  is 
the  worst  leper  centre  in  either  Province,  the  consumption  of  badly  cooked  fish 
is  extremely  rare.  On  the  other  hand,  it  is  common  among  the  Nepalese  races, 
who  fulfil  the  conditions  necessary  according  to  Mr.  Hutchinson,  for  (1)  the 
fish  they  eat  is  badly  cured,  (2)  it  is  eaten  very  largely,  (3)  it  is  in  a  state  of 
partial  decomposition  and  (4)  it  is  imported  from  distant  places.  In  every 
bazar  frequented  by  the  Nepalese  such  badly  cured  fish  may  be  seen.  Its 
condition  will  be  sufficiently  described  by  a  quotation  from  Mr.  Inglis  an  old 
planter  of  North  Bihar.  Large  quantities  of  dried  fish  are  sent  to  Nepal,  and 
exchanged  for  rice  and  other  grains,  or  horns,  hides  and  blankets.  The  fish- 
drying  is  done  very  simply  in  the  sun.  It  is  generally  left  till  it  is  half  putrid 
and  taints  the  air  for  miles.  The  sweltering,  half-rotting  mass,  packed  in  filthy 
bags,  and  slung  on  ponies  or  bullocks,  is  sent  over  the  frontier  to  some  village 
bazar  in  Nepal.  The  track  of  a  consigmnent  of  this  horrible  filth  can  be  recog- 
nized from  very  far  away.  The  perfume  hovers  on  the  road,  and  as  you  are 
riding  up  and  get  the  first  sniff  of  the  putrid  odour,  you  know  at  once  that  the 
Nepalese  market  is  being  recruited  by  a  fresh  accession  of  very  stale  fish.  If 
the  taste  is  at  all  equal  to  the  smell,  the  rankest  witches'  broth  ever  brewed  in 
a  reeking  cauldron  would  be  preferable.  The  localities  where  the  Nepalese  are 
found  in  greatest  strength  have  little  leprosy,  viz.,  Darjeeling,  where  the  propor- 

38 


tion  of  male  lepers  per  100,000  is  45,  and,  Sikkira,  where  it  falls  to  16.  The 
figures  for  Nepalese  castes,  however,  show  that  the  incidence  of  leprosy  is  very 
low;  out  of  35,000  persons  belonging  to  different  Nepalese  castes  in  Sikkim 
only  six  are  lepers." 

In  the  Central  provinces  and  Berar  the  local  variation  in  leprosy  in- 
cidence is  very  considerable,  the  average  being  as  high  as  46  per  100,000 
of  population.  The  total  number  of  lepers  in  the  two  provinces  is  7,307. 
It  is  pointed  out  that  women  seem  to  be  attacked  by  the  disease  at  an 
earlier  age  than  men,  and  that  the  higher  ratio  of  male  lepers  is  in  part 
accounted  for  by  the  more  successful  concealment  of  female  cases,  as  well 
as  by  the  apparently  higher  mortality  "among  leprous  women  who  will 
not  so  readily  solicit  charity  as  men  by  displaying  the  disease  in  public." 

For  Madras  the  local  census  report  is  unfortunately  not  available,  nor 
for  the  province  of  Bombay.  For  the  United  provinces  of  Agra  and  Oudh 
(Allahabad,  1912)  the  report  prepared  by  E.  A.  H.  Blimt,  I.C.S.,  contains 
a  considerable  amount  of  extremely  interesting  and  suggestive  data  indi- 
cating also  a  wide  variation  in  local  incidence,  from  a  minimum  rate  of 
less  than  10  per  100,000  to  a  maximimi  of  over  100.  The  total  number  of 
lepers  in  1911,  including  native  states,  was  about  14,500,  which  compares 
with  not  quite  12,000  in  1901.  The  increase  is  equivalent  to  about  24  per 
cent.  The  Himalayan  division  has  incomparably  the  largest  number  of 
lepers,  although  there  is  a  decrease  both  amongst  males  and  females,  and 
the  figures  are  obscured  by  the  presence  of  several  asylums.  In  marked 
contrast  to  previous  observations,  in  this  report  the  view  is  advanced  that 
"since  the  life  of  a  leper  seldom  exceeds  twenty  years,  it  is  obvious  that  a 
very  large  part  of  any  increase  must  be  due  to  fresh  cases."  Unless  the 
majority  of  cases  are  of  the  anesthetic  type,  it  is  doubtful  whether  the 
average  after-lifetime  of  a  leper  would  exceed  twelve  years.  It  is  observed 
that  "leprosy  has  at  all  times  proved  a  medical  puzzle;  despite  all  the 
attention  it  has  received,  its  causation  is  still  unkno^vn  and  a  cure  is  un- 
known." This  statement  might  easily  mislead  those  who  are  not  aware  of 
the  fact  that  the  causative  factor,  or  bacillus  lepra  has  been  thoroughly 
identified  and  is  easily  recognized,  although  the  form  of  transmission  or 
spread  of  the  disease  still  remains  shrouded  in  mystery.  Reference  is  made 
to  the  Lepers'  act  of  1898,  which  contains  a  provision  that  "lepers  may 
be  forbidden  to  follow  callings  connected  with  the  preparation  and  sale 
of  food,  drink,  drugs,  tobacco  and  clothing,  domestic  service,  medical 
practice,  midwifery,  washing  clothes,  hair  cutting,  shaving,  or  callings 
which  necessitate  the  handling  of  food  and  drink:  and  also  to  bathe, 
wash  clothes  in,  or  take  water  from,  certain  wells  or  tanks  or  use  any 
public  carriage  save  a  railway  carriage."  Finally,  it  is  pointed  out  in  the 
report  that  "the  great  majority  of  lepers  are  not  and  cannot  be  segregated." 
Since  the  total  number  of  lepers  in  British  territory  was  14,143  in  1911, 
aside  from  377  lepers  in  native  states,  the  importance  of  this  conclusion 
is  obvious. 

39 


The  Census  Report  of  the  Northwest  Frontier  province  (Peshawar, 
1912),  prepared  by  C.  Latimer,  LC.S.,  also  calls  attention  to  the  diminu- 
tion of  the  disease  from  an  actual  number  of  294  cases  in  1901  to  282 
in  1911.  Attention  is  directed  to  the  excessive  frequency  of  the  disease  in 
the  hill  districts  and  to  the  incidence  of  leprosy  in  the  province  of  Kash- 
mir, which  for  1901  experienced  a  rate  of  72  per  100,000  for  males  and 
36  for  females.  It  is  observed  in  this  connection  that  "whether  this  result  is 
to  be  regarded  as  connecting  leprosy  with  syphilis,  which  is  known  to  be 
common  in  the  hills,  or  whether  the  variation  is  due  to  difference  in  the 
food  eaten,  it  is  impossible  to  say,"  for  "the  causes  which  predispose  to 
the  disease  do  not  seem  to  have  been  accurately  determined;  and  no  cor- 
respondeifce  could  be  traced  between  the  physical  and  climatic  character- 
istics, or  between  the  race  and  staple  diet  of  their  inhabitants." 

For  the  native  state  of  Travancore,  the  census  report  for  1911,  pre- 
pared by  IN'.  Subramhanya  Aiyar  (Trivandrum,  1912),  the  local  frequency 
is  given  as  49  male  lepers  per  100,000  of  population,  and  16  females. 
Since  1901  "there  has  been  a  perceptible  decrease  in  the  number  of  lepers, 
the  decline  amounting  to  21  per  cent."  Attention  is  directed  to  the  sudden 
increase  in  leprosy  during  the  age  period  10-20,  when  apparently  the  risk 
of  infection  is  greatest. 

In  the  native  state  of  Coorg,  the  report  for  1911,  prepared  by  J. 
Chartres  Molony,  LC.S.  (Madras,  1912),  contains  no  extended  observa- 
tions on  the  subject  of  leprosy,  but  the  statistical  results  show  a  very 
marked  decline  in  relative  frequency,  or,  for  the  male  population  from  25 
per  100,000  in  1881  to  6  in  1911,  while  for  females  the  rate  has  declined 
from  23  in  1881  to  4  in  1901,  no  rate  being  given  for  the  last  census  year. 

Finally,  in  the  native  state  of  Baroda,  according  to  the  administration 
report,  1917-1918,  the  number  of  lepers  treated  at  the  asylum  was  160 
against  169  in  1916-17,  but  such  figures  are,  however,  not  very  trustworthy 
as  an  index  of  a  possible  diminution  or  increase  in  frequency,  as  is  made 
evident  by  the  statement  that  71  patients  absconded  during  the  year  under 
review,  the  question  now  being  under  consideration  to  wall  in  the  asyliun 
to  increase  the  difficulty  of  escapes.* 

*0n  the  proposed  establishment  of  more  and  model  leper  farm  colonies  in  India  see  the  British  Medical 
Journal,  of  December  20,  1919. 


40 


APPENDIX  B 

Leprosy  Statistics 

Table  I 

Analysis  of  Leper  Admissions  to  the  Louisiana  Leper  Home 

Rates  per 

1,000,000 

Population 

New  Cases 

Calendar               Louisiana 

Admitted  each  year  (z) 

Deaths 

Remaining  (x) 

Year                 Population 

No. 

Rate 

No. 

Rate 

No. 

Rate 

1894               1,223,801 

8 

6.5 

— 

— 

— 



1895                1,250,105 

18 

14.4 

4 

3.2 

— 

— 

1896                1,276,409 

3 

2.4 

3 

2.4 

22 

17.2 

1897                1,302,713 

6 

4.6 

4 

3.1 

— 

— 

1898                1,329,017 

5 

3.8 

1 

— 

23 

17.3 

1899                1,355,321 

2 

1.5 

3 

2.2 

— 

— 

1900               1,381,625 

7 

5.1 

6 

4.3 

30 

21.7 

1901                1,409,101 

10 

7.1 

5 

3.5 

— 

— 

1902               1,436,577 

10 

7.0 

7 

4.9 

38 

26.5 

1903                1,464,053 

7 

4.8 

9 

6.1 

— 

— 

1904               1,491,529 

13 

8.7 

2 

1.3 

38 

25.5 

1905                1,519,005 

10 

6.6 

2 

1.3 

— 

— 

1906                1,546,481 

11 

7.1 

3 

1.9 

47 

30.4 

1907               1,573,957 

8 

5.1 

1 

0.6 

— 

— 

1908               1,601,434 

8 

5.0 

1 

0.6 

47 

29.3 

1909               1,628,911 

18 

11.1 

7 

4.3 

— 

— 

1910               1,656,388 

17 

10.3 

3 

1.8 

66 

39.8 

1911                1,683,864 

15 

8.9 

7 

4.2 

— 

— 

1912               1,711,340 

12 

7.0 

■      4 

2.3 

74 

43.2 

1913               1,738,816 

27 

15.5 

8 

4.6 

— 

— 

1914               1,773,482 

22 

12.4 

5 

2.8 

87 

49.1 

1915               1,801,306 

23 

12.8 

9 

5.0 

— 

— 

1916               1,829,130 

22 

12.0 

16 

8.7 

103 

56.3 

1917               1,856,954 

9 

4.8 

4 

2.2 

— 

— 

1918               1,884,778 

15 

8.0 

4 

2.1 

89 

47.2 

1919               1,912,602 

16 

8.4 

5 

2.6 

91 

47.6 

1920               1,940,426 

— 

— 

— 

— 

87 

44.8 

(z)    Actual   count   of   cases. 

(x)    Remaining  at  time  Report  is  made  : 

in  April. 

Data  from  Biennial 

Reports  of  the  Board  of  Control. 

(Incomplete 

records.) 

Table  II 

Analysis  of  Admissions  to  Leper  Home,  La. 

For  the  Period  December  1,  1894,  to  December  31,  1915 


Age  on 

Males 

Females 

Males  and 

Admission 

Cases 

Cases 

Females,  Cases 

-10 

4 

1 

5 

10-14 

16 

8 

24 

15-19 

21 

11 

32 

20-29 

34 

15 

49 

30-39 

28 

12 

40 

40-49 

22 

16 

38 

50-59 

25 

14 

39 

60-69 

7 

8 

15 

70  and  Over 

4 

4 

8 

Unknown 

5 

2 

7 

166 


91 


257 


All  Ages 
Average  Age 

on  Admission  33.8  37.3  35.0 

Data  from  Biennial  Reports  of  the  Board  of  Control  for  the  Leper  Home. 


41 


Table  III 

Lepers  at  Isolation  Hospital,  San  Francisco,  California 

Rates  per  1,000,000  of  Population 


Year  Ending 

Admissions 

Deaths 

Remaining 

June  30 

Population 

No. 

Bate 

No. 

Rate 

No. 

Rate 

1900 

342,782 

1 

2.9 

2 

5.8 

19 

55.4 

1901 

350,195 

5 

14.3 

2 

5.7 

21 

60.0 

1902 

357,608 

9 

25.2 

1 

2.8 

27 

75.5 

1903 

365,021 

3 

8.2 

1 

2.7 

26 

71.2 

1904 

372,434 

3 

8.1 

3 

8.1 

19 

51.0 

1905 

379,847 

. — 

— 

4 

10.5 

15 

39.5 

1906 

387,260 

4 

10.3 

3 

7.7 

20 

51.6 

1907 

394,673 

— 

— 

4 

10.1 

15 

38.0 

1908            1 

402,086 

4 

9.9 

— 

— 

17 

42.3 

1909 

409,499 

3 

7.3 

3 

7.3 

16 

39.1 

1910 

416,912 

5 

12.0 

3 

7.2 

17 

40.8 

1911 

424,325 

2 

4.7 

— 

— 

18 

42.4 

1912 

431,738 

5 

11.6 

2 

4.6 

18 

41.7 

1913 

439,151 

5 

11.4 

3 

6.8 

16 

36.4 

1914 

446,564 

4 

9.0 

3 

6.7 

14 

31.4 

1915 

453,977 

1 

2.2 

1 

2.2 

15 

33.0 

1916 

461,390 

1 

2.2 

2 

4.3 

20 

43.3 

1917 

468,803 

13 

27.7 

3 

6.4 

17 

36.3 

1918 

476,216 

7 

14.7 

5 

10.5 

19 

39.9 

1919 

483,629 

1 

2.1 

1 

2.1 

20 

41.4 

Data  from  the  Reports  of  the  Department  of  Public  Health,  San  Francisco,  Calif. 


Table  IV 
Leprosy  in  Massachusetts,  Penikese  (Island)  Hospital^ 


Ri 

ates 

per  1,000,000 

Population 

Year  Ei 

iding 

Admitted 

Died 

Remaining 

Novem) 

DerSO 

Population 

No.          Rate 

No.  ' 

Rate 

No. 

Rate 

1905 

3,003,680 

5          1.7 

— 

— 

5 

1.7 

1906 

3,076,224 

—          — 

— 

— 

5 

1.6 

1907 

3,148,768 

4          1.3 

1 

0.3 

8 

2.5 

1908 

3,221,312 

1          0.3 

— 

— 

8 

2.5 

1909 

3,293,856 

3          0.9 

— 

— 

10 

3.0 

1910 

3,366,416 

1          0.3 

— 

— 

11 

33 

1911 

3,431,792 

2          0.6 

— 

— 

13 

3.8 

1912 

3,497,168 

4          1.1 

1 

0.3 

15 

4.3 

1913 

3,562,544 

2          0.6 

1 

0.3 

15 

4.2 

1914 

3,627,920 

—           — 

1 

0.3 

13 

3.6 

1915 

3,693.310 

1          0.3 

3 

0.8 

11 

3.0 

1916 

3,758,688 

2          0.5 

4 

1.1 

9 

2.4 

1917 

3,824,067 

3          0.8 

1 

0.3 

11 

2.9 

1918 

3,889,446 

2          0.5 

— 

— 

12 

3.1 

1919 

3,954,825 

2          0.5 

— 

— 

13 

3.3 

D 

ata  from  the  Reports 

of  the  State  Board  of  Charities 

;  of  Massachusetts. 

*0f  the  29  lepers  apprehended  in  the  state  of  Massachusetts  during  the  period  1882-1915,  the  distribu- 
tion by  types  of  disease  was  as  follows:  Tubercular  22,  or  75.9  per  cent.;  anesthetic  4,  or  13.8  per  cent.; 
mixed  2,  or  6.9  per  cent. ;  unknown  1,  or  3.4  per  cent.  Of  the  total  number  of  admissions  23  were  males 
and  6  were  females ;  of  the  latter,   4  were  of  the  tubercular  type. 

Of  the  23  male  cases  apprehended,  9,  or  39.1  per  cent.,  died  during  the  period  under  review;  or, 
if  the  tubercular  cases  are  separately  considered,  out  of  18  cases,  7  died,  or  38.9  per  cent.  Of  the  6 
female  cases,  2  died,  or  33.3  per  cent.  Of  the  29  cases,  10,  or  34.1  per  cent.,  were  of  the  age  period 
20-29,  which  may  be  considered  the  age  period  most  liable  to  infection.  Of  the  29  cases  only  4  were  natives 
of  the  United  States,  and  of  these,  two  were  born  in  the  Hawaiian  Islands,  1  in  a  foreign  country  and  only 
1  in  the  state  of  Louisiana.  The  remainder  had  come  to  this  country  from  the  Azores,  Cape  Verde,  British 
West  Indies,   China,  Greece,  Italy,  Japan,  Russia,   Sweden  and  Syria. 

42 


Table  V 
Leprosy  in  the  United  States  Registration  Area 


Year 

1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 


Population 

30,794,273 
31,370,952 
32,029,815 
32,701,083 
33,349,139 
34,094,605 
41,983,419 
43,016,990 
46,789,913 
50,870,518 
53,843,896 
59,275,977 
60,427,133 
63,299,164 
65,989,295 
67,336,992 
71,621,632 
75,527,486 
81,868,104 


Deaths 

4 

6 

5 

4 

4 

8 

3 

7 
11 

9 
10 

7 
11 

6 
12 
13 
11 
17 
24 


Rate  per 
Million 

0.13 
0.19 
0.16 
0.12 
0.12 
0.23 
0.07 
0.16 
0.24 
0.18 
0.19 
0.12 
0.18 
0.09 
0.18 
0.19 
0.15 
0.23 
0.29 


Table  VI 

Deaths  from  Leprosy  in  the  United  States  Registration  Area 

BY  States,  1907-1918 

, ^YEARS . 

States  '07        '08        '09       '10        '11        '12       '13        '14        '\5        '16        '17        '18     Total 

CaUfornia  353243-33—        6^      37 

Connecticut  —      —      —      —      —      —        1                "                   ~      ~        f- 

Florida  _2-l---211^19 

Indiana  — •      —      —       —      —        1                                                        -,,^ 

Louisiana*  1        2—        2      —      -      —      —        1      —      —      11      17 

Massachusetts  1      —      —      —      —        1        1        1        3        4        1      —      12 

Michigan  —       —      —      —      —        2                            2—                            4 

Minnesota  __—         1         2—         1—         1         1      —      —        7 

New  Jersey  _      —      —      —      —      ~~      ~      ~      ~      ~Z        ]      ~^      ^n 

New  York  1-211112-442      19 

Ohio                   -  ^  —  ~~~~~~'~~''Z1.       \ 

Pennsylvania         —  1  —  —  —  —  —        1  ^        ^ 

Rhode  Island        __  —  —  —  —  —  —        1  —      —      —        1 

South  Carolina     —  —  —  2  —  —  —        2—  1        1        1        7 

Texas                      i  _  _  _  _  _  2        1        1  -        2      -        7 

Washington           —  —  —  —  —  —  —  —  ^                  j 

Wisconsin              —  —  —  1  —  —  — 
Registration  cities 

in  other  States  —  —  4  —  —  3  —  —  ' 

139 


♦For  years  previous  to  1918,  data  for  New  Orleans  only. 


43 


Year 

1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 


Table  VII 

lY  FROM 

Leprosy  in 

Cuba,  1903-1914 

Deaths 

Rate  per 

Population 

from  Leprosy 

Million 

1,751,366 

17 

9.7 

1,810,889 

31 

17.1 

1,870,412 

17 

9.1 

1,929,935 

29 

15.0 

1,989,458 

39 

19.6 

2,048,980 

47 

22.9 

2,082,691 

30 

14.4 

2,116,402 

25 

11.8 

2,150,112 

35 

16.3 

2,183,823 

53 

24.3 

2,217,534 

37 

16.7 

2,251,245 

43 

19.1 

2,284,956 

45 

19.7 

Source:  Sanidad  y  Beneficencia,  Boletin  Oficial  de  la  Secretaria,  Habana. 


Table  VIII 


Leprosy  in  Cuba 


Year 

1909 
1910 
1911 
1912 
1913 
1914 


Population 

2,116,402 
2,150,112 
2,183,823 
2,217,534 
2,251,245 
2,284,956 


Reported  Cases 

Remaining  at 

End  of  Each  Year 

321 
343 
350 
338 
341 
351 


Rate  per 
Million  of 
Population 

151.7 
159.5 
160.3 
152.4 
151.5 
153.6 


Data  from  Sanidad  y  Beneficencia,  Boletin  Oficial  de  la  Secretaria,  Habana. 

Table  IX 

Statistics  of  the  Leper  Colony,  Goat  Island,  San  Juan,  Porto  Rico, 

1905-1919 


Year 

1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 


Population 

of 
Porto  Rico 

1,042,342 
1,058,134 
1,073,926 
1,089,718 
1,105,510 
1,121,302 
1,137,094 
1,152,886 
1,168,678 
1,184,470 
1,200,262 
1,216,054 
1,231,846 
1,247,638 
1,263,430 


Rate  Per 

Inmates  on 

Million  of 

June  30 

Population 

18 

17.3 

25 

23.6 

25 

23.3 

19 

17.4 

24 

21.7 

25 

22.3 

25 

22.0 

28 

24.3 

28 

24.0 

36 

30.4 

39 

32.5 

39 

31.3 

39 

30.9 

Source :  Annual  Reports  of  the  Governor  of  Porto  Rico  to  the  Secretary  of  War. 


44 


Table  X 

Leprosy  in  Panama  Canal  Zone,  Palo  Seco  Leper  Asylum 

Rates  per  1,000,000  Population  of  Panama  Canal  Zone  and  Cities  of 

Colon  and  Panama 


Ada: 

lissions 

Deaths 

Remainine 

Year 

Population 

No. 

Rate 

No.         Rate 

No. 

Rate 

1907 

102,133 

— 

1          9.8 

14 

137.1 

1908 

120,097 

14 

116.6 

—           — 

22 

183.2 

1909 

135,180 

24 

177.5 

1          7.4 

34 

251.5 

1910 

151,591 

15 

99.0 

3        19.8 

36 

237.5 

1911 

156,936 

24 

152.9 

2        12.7 

49 

312.2 

1912 

146,510 

12 

81.9 

7        47.8 

48 

327.6 

1913 

129,104 

15 

116.2 

9        69.7 

45 

348.6 

1914 

123,592 

14 

113.3 

6        48.5 

50 

404.6 

1915 

121,650 

11 

90.4 

2        16.4 

58 

476.8 

1916 

116,918 

21 

179.6 

9        77.0 

66 

564.5 

1917 

(x)    114,003 

11 

96.5 

7        61.4 

67 

587.7 

1918 

(x)    109,737 

21 

191.4 

8        72.9 

76 

692.6 

(x)    Excluding  the  military  for  last  six  months  of  1917  and  the  whole  of  1918. 

Data  from  Reports  of  the  Health  Department  of  the  Panama  Canal. 


Table  XI 

Leprosy  in  Panama  Canal  Zone,  Palo  Seco  Leper  Asylum 
Number  of  Deaths  of  Lepers  from  1907-1915 


Type  of  Disease 
on  Admission 

Tubercular 
Anesthetic 
Mixed 
Total 


Males 
Number 

18 
3 
3 

24 


Females 
Number 

6 
2 
1 
9 


Males  and 
Females 
Number 

34 

5 

4 
33 


Nativity  on  Admission 


Number  Males 

Nativity 

White 

Black 

United  States 

2 

— 

Spain 

1 

— 

Panama 

— 

6 

Colombia 

— 

2 

Costa  Rica 

— 

1 

Jamaica 

— 

5 

Barbados 

— 

4 

Antigua 

— 

1 

China 

— 

1 

Peru 

— 

1 

Number  Females 
White  Black 


Total  3  21  —  9 

Source :  From  data  received  from  Palo  Seco  Leper  Asylum. 


Number 

Males  and  Females 

White        Black 


13 
3 
1 
6 
4 
1 
1 
1 


30 


Note: — The  average  duration  of  the  disease  has  been  7.5  years;  or,  roughly,  6.8  years  for  tubercular 
cases,  8.8  years  for  anesthetic  cases,  and  9.8  years  for  mixed  cases.  For  ages  under  15  the  average  dura- 
tion was  6.3  years,  for  ages  15  to  44  it  was  6.8  years,  and  for  ages  45  and  over,  9.7  years. 


45 


Table  XII 
Mortality  from  Leprosy  in  the  City  of  Rio  de  Janeiro,  1890-1918 


Year 

1890 
1891 
1892 
1893 
1894 
1895 
1896 
1897 
1898 
1899 
1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 


Population 

429,848 
440,118 
450,636 
461,411 
472,454 
483,773 
495,380 
507,286 
519,503 
532,042 
544,917 
558,140 
571,728 
585,695 
600,067 
614,831 
625,756 
636,018 
637,089 
649,362 
669,781 
708,669 
749,376 
754,839 
738,950 
737,888 
719,316 
696,284 
700,443 


Deaths 

9 
13 
14 
20 
18 
18 
19 
18 
13 
22 
10 
16 
19 
20 
23 
25 
22 
34 
20 
14 
11 
29 
25 
16 
27 
21 
19 
21 
23 


Rate  per 
Million 

20.9 
29.5 
31.1 
43.3 
38.1 
37.2 
38.4 
35.5 
25.0 
41.4 
18.4 
28.7 
33.2 
34.1 
38.3 
40.7 
35.2 
53.5 
31.4 
21.6 
16.4 
40.9 
33.4 
21.2 
36.5 
28.5 
26.4 
30.2 
32.8 


Source:   Annuario  de  Estatistica  Demographo-Sanitaria  de  Rio   de  Janeiro,  and 
Boletim  Mensal  de  Estatistica  Demographo-Sanitaria. 

Table  XIII 
Mortality  from  Leprosy,  City  of  Sao  Paulo,  Brazil,  1901-1917 


Year 

1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 


Population 

286,000 
293,200 
300,400 
307,600 
314,800 
322,000 
329,200 
336,400 
343,600 
350,800 
358,000 
400,000 
480,000 
485,000 
500,000 
484,901 
452,028 


No. 
Deaths 

5 

10 

4 

6 

7 
17 
11 
11 

6 
23 
21 
24 
19 
21 
23 
32 
26 


Rate  per 
Million 

17.5 
34.1 
13.3 
19.5 
22.2 
52.8 
33.4 
32.7 
17.5 
65.6 
58.7 
60.0 
39.6 
43.3 
46.0 
66.0 
57.5 


Data 


from  Annuario  Demographico,  Seccao  de  Estatistica  Demographo-Sanitaria 
de  Sao  Paulo. 

Annuario  de  Estatistica  Demographo-Sanitaria  de  Rio  de  Janeiro. 
Boletim   Hebdomadario   de  Estatistica   Demographo-Sanitaria   de   Sao 
Paulo. 

46 


Table  XIV 

Deaths  from  Leprosy  in  the  Federal  District  of 

Rio  de  Janeiro,  Brazil 

By  Sex  and  Age 

1909-1918 

]\L\LES 


Ages  at 

Rate  per 

Death 

Population 

Deaths 

MiUion 

Under  19 

2,115,954 

6 

2.8 

20-29 

1,247,036 

23 

18.4 

30-39 

885,174 

27 

30.5 

40-49 

591,560 

38 

64.2 

50-59 

293,614 

30 

102.2 

60-69 

120,805 

19 

157.3 

70  and  Over 

47,131 

5 

106.1 

FEMALES 

Rate  per 

Population 

Deaths 

Million 

1,822,555 

5 

2.7 

790,822 

9 

11.4 

569,392 

15 

26.3 

389,735 

13 

33.4 

226,700 

14 

61.8 

118,012 

10 

84.7 

64,077 

9 

140.5 

All  Ages  5,301,274        148  27.9  3,981,293  75 

Data  from  Annuario  de  Estatistica  Demographo-Sanitaria  de  Rio  de  Janeiro. 

Table  XV 

Mortality  from  Leprosy  in  the  Federal  District  of 

Rio  DE  Janeiro,  Brazil 

By  Sex  and  Nativity 

1909-1918 


18.8 


MALES 


females 


Rate  per 

Nativity 

Population 

Deaths 

Million 

Brazilian 

3,575,179 

97 

27.1 

Portugese 

1,164,160 

33 

28.4 

Italian 

196,147 

7 

35.7 

Spanish 

161,159 

5 

31.0 

Other  European      66,266 

4 

60.4 

Turko-Arabic 

21,735 

2 

92.0 

AU  Other 

116,628 

— 

Population 

3,298,899 
361,900 
96,347 
75,246 
54,146 
10,749 
84,006 


Deaths 

64 
6 
1 
1 

1      . 
1 
1 


Rate  per 
MiUion 

19.4 
16.6 
10.4 
13.3 
18.5 
93.0 
11.9 


All  Nativities       5,301,274        148  27.9  3,981,293  75  18.8 

Data  from  Annuario  de  Estatistica  Demographo-Sanitaria  de  Rio  de  Janerio. 

Table  XVI 
Mortality  from  Leprosy,  City  of  Recife  (Pernajmbuco),  Brazil 

1907-1920 


Year 

1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 


Population 

159,480 
166,110 

172,740 
179,370 
186,000 
210,000 
230,000 
232,500 
235,000 
237,500 
240,000 


No.  of 
Deaths 

18 
19 
12 
12 

3. 
10 
10 

6 

8 

8 

9 


Rate  per 
Million 

112.9 
114.4 
69.5 
66.9 
16.1 
47.6 
43.5 
25.8 
34.0 
33.7 
37.5 


Data  from  Annuario  de  Estatistica  Demographo-Sanitaria  de  Rio  de  Janeiro. 
Boletim  Mensal  de  Estatistica  Demographo-Sanitaria  do  Municipio  do  Recife. 


47 


Table  XVII 

Deaths 

FROM  Leprosy 

AND  Number  of  Inmates 

IN  Leper  Asylums, 

Venezueia, 

1905-1918 

Inmates  in 

Deaths  from 

Rate  per 

Leper  Asylums 

Rate  per 

Year 

Population 

Leprosy 

Million 

December  31 

Million 

1905 

2,609,108 

81 

31.0 

1906 

2,627,069 

74 

28.2 

1907 

2,649,995 

51 

19.2 

666 

251.3 

1908 

2,664,233 

37 

13.9 

632 

237.2 

1909 

2,685,432 

48 

17.9 

621 

231.2 

1910 

2,713,523 

22 

8.1 

612 

225.5 

1911 

2,743,833 

24 

8.7 

611 

222.7 

1912 

2,755,630 

62 

22.5 

582 

211.2 

1913 

^      2,780,281 

57 

20.5 

523 

188.1 

1914 

2,805,269 

25 

8.9 

499 

177.9 

1915 

2,818,173 

45 

16.0 

676 

239.9 

1916 

2,827,762 

71 

25.1 

650 

229.9 

1917 

2,848,121 

33 

11.6 

626 

219.8 

1918 

2,868,480 

28 

9.8 

753 

262.5 

Data   from   Anuario   Estadistico   de   Venezuela   and   Memoria   del  Ministerio   de 
Fomento. 


Table  XVIII 

Mortality  of  Lepers  in  the  Lazaretto  of  Barbados 

For  the  Period,  1890-1917 

Males  and  Females 


Causes  of  Death 

Dysentery 

Leprosy 

Tuberculous  Lungs 

Other  General 

Apoplexy 

Paralysis 

Other  Nervous 

Organic  Heart  Disease 

Other  Circulatory 

Respiratory 

Diarrhea  and  Enteritis 

Other  Digestive 

Brights  Disease 

Other  Urinary 

Gangrene 

Ill-defined 


Tubercular 
Males    Females 
No. 


No. 

2 

125 

17 

4 

1 

2 
4 

4 
7 
1 

1 

3 
2 


1 
79 
12 

3 

1 
1 
6 
1 
1 
2 
3 


Anesthetic 

Males    Females 

No.  No. 

2  — 

21 
7 
5 
6 
3 
1 


All  Causes  173      118  68 

Data  from  The  Barbados  Blue  Book. 


29 

10 

2 

3 

2 
1 

2 
2 


54 


Mixed 
Males    Females 
No.         No. 


—  2 


All  Types 

Males    Females 

No.    No. 


4 
149 

24 

10 
6 
4 
3 

12 
1 
6 

10 
3 
2 
2 
4 
6 


1 

112 
22 
5 
3 
3 
2 
10 
3 
1 
3 
3 
1 

4 

7 


246   180 


48 


Table  XIX 

Leprosy  in  India, 

1911 

Number  of 

Lepers  by  Aj 

ge  and  Sex 

ALL  INDIA 

NATIVE  STATED 

5 

Ages 

Males 

Females 

Total 

Males 

Females 

Total 

Under  5 

245 

188 

433 

59 

51 

110 

5-9 

568 

419 

987 

99 

99 

198 

10-14 

1,692 

1,144 

2,836 

306 

223 

529 

15-19 

3,185 

1,814 

4,999 

490 

311 

801 

20-24 

4,752 

2,344 

7,096 

738 

425 

1,163 

25-29 

7,174 

2,653 

9,827 

1,035 

449 

1,484 

30-34 

9,517 

3,327 

12,844 

1,342 

511 

1,953 

35-39 

9,761 

2,754 

12,515 

1,282 

422 

1,704 

40-44 

12,542 

3,558 

16,100 

1,929 

702 

2,631 

45-49 

8,503 

2,252 

10,755 

1,082 

316 

1,398 

50-54 

9,617 

3,025 

12,642 

1,515 

545 

2,060 

55-59 

3,974 

1,260 

5,234 

537 

152 

689 

60-64 

5,553 

1,951 

7,504 

823 

324 

1,147 

65-69 

1,437 

472 

1,909 

192 

61 

253 

70  and  over 

2,438 

892 

3,330 

356 

125 

481 

Unknown 

66 

17 

83 
109,094 

49 

11 
4,827 

60 

Total 

81,024 

28,070 

11,834 

16,661 

Rate  per  100,000 

of  population    50.2 

18.2 

34.6 

32.5 

14.0 

23.5 

Data  from  Census 

of  India,  1911,  Volume  I. 

Table  XX 

Statistics  of  the  Leper  Settlement  at  Molokai,  Hawaii 

Admissions,  Inmates  and  Deaths  of  Lepers,  1866-1919 

Rate  per  100,000  Population  of  Hawaii 


Admissions  to 

Calendar 

Molokai 

Year 

Number            Rate 

1866  (a) 

141          223.9 

1867 

91          146.9 

1868 

131          215.0 

1869 

190          317.0 

1870 

57            96.7 

1871 

178          307.4 

1872 

91          159.9 

1873 

415          727.1 

1874 

78          136.2 

1875 

178          309.9 

1876 

75          130.2 

1877 

122          211.1 

1878 

209          360.4 

1879 

92          149.0 

1880 

51            77.8 

1881 

195          281.5 

1882 

70            95.8 

1883 

300         390.6 

1884 

108          134.0 

1885 

103          125.4 

1886 

43           51.4 

1887 

220          258.0 

(a)    Settlement  established  Janua 

Number  of  Lepers 

in 

Molokai 

December  31 

Number 

Rate 

115 

182.7 

170 

274.4 

267 

438.1 

392 

654.1 

392 

665.3 

518 

894.5 

546 

959.6 

810 

1,419.1 

731 

1,276.7 

754 

1,312.7 

704 

1,221.8 

694 

1,200.6 

792 

1,365.9 

688 

1,114.2 

589 

899.0 

654 

944.0 

613 

839.2 

763 

993.3 

702 

871.2 

663 

807.1 

600 

716.7 

708 

830.2 

Deaths 

from 

all  Causes 

Number 

Rate 

36 

57.2 

24 

38.7 

27 

44.3 

59 

98.4 

57 

96.7 

52 

89.8 

63 

110.7 

142 

248.8 

141 

246.2 

149 

259.4 

119 

206.5 

129 

223.2 

111 

191.4 

194 

314.2 

151 

230.5 

129 

186.2 

111 

152.0 

150 

195.3 

167 

207.3 

142 

172.9 

101 

120.6 

111 

130.2 

Table  XX  (Continued) 


Numl 

ber  of  Lepers 

Admissions  to 

in  Molokai 

Deaths  from 

Calendar 

Molokai 

December  31 

all  Causes 

Year 

N'mnber 

Rate 

Nmnber 

Rate 

Number 

Rate 

1888 

571 

657.4 

1,033 

1,189.4 

236 

271.7 

1889 

307 

347.1 

1,187 

1,342.4 

149 

168.5 

1890 

185 

205.6 

1,213 

1,347.9 

158 

175.6 

1891 

141 

151.4 

1,142 

1,225.8 

210 

225.4 

1892 

105 

109.0 

1,095 

1,136.7 

152 

157.8 

1893 

209 

210.0 

1,153 

1,158.7 

151 

151.8 

1894 

129 

125.6 

1,123 

1,093.7 

159 

154.9 

1895 

105 

99.2 

1,087 

1,027.0 

141 

133.2 

1896 

142 

130.3 

1,115 

1,022.7 

114 

104.6 

1897 

,      124 

103.1 

1,099 

913.8 

140 

116.4 

1898 

75 

57.0 

1,059 

805.3 

114 

86.7 

1899 

61 

42.7 

1,014 

710.3 

104 

72.9 

1900 

109 

70.8 

983 

638.3 

134 

87.0 

1901 

94 

59.6 

900 

570.4 

172 

109.0 

1902 

80 

49.5 

874 

540.9 

106 

65.6 

1903 

114 

68.9 

872 

527.3 

101 

61.1 

1904 

92 

54.4 

856 

506.0 

107 

63.3 

1905 

95 

54.9 

854 

493.8 

95 

54.9 

1906 

64 

36.2 

834 

471.9 

84 

47.5 

1907 

78 

43.2 

809 

448.1 

88 

48.7 

1908 

32 

17.4 

771 

418.3 

59 

32.0 

1909  (b) 

11 

11.4 

723 

376.0 

34 

35.4 

1910  (c) 

47 

24.6 

614 

321.3 

90 

47.1 

1911 

40 

19.9 

592 

295.2 

61 

30.4 

1912 

91 

43.5 

622 

297.4 

64 

30.6 

1913 

113 

51.9 

683 

313.7 

49 

22.5 

1914 

67 

29.5 

666 

292.9 

75 

33.0 

1915 

49 

21.2 

638 

275.9 

62 

26.8 

1916 

57 

24.0     . 

629 

264.7 

66 

27.8 

1917 

34 

13.6 

587 

234.2 

62 

24.7 

1918 

89 

34.7 

608 

237.3 

67 

26.2 

1919 

61 

23.1 

611 

231.7 

57 

21.6 

(b)    Six 

months  ending  June  30. 

(c)   Years  ending  June 

30,   after  1910. 

Source:  For  1866-1908,  Report  of  the  Board  of  Health  of  Hawaii,  1909,  p.  186; 
for  subsequent  years,  see  Annual  Reports  of  the  Territorial  Board  of  Health. 


Table  XXI 

Leprosy 

IN  Hawaii 

Type  oi 

■  Leprosy 

Molokai, 

1901-1913 

Tx-ix- 

Tubercular 
Anesthetic 
Mixed 
Not  Given 

Number 
of  Cases 

384 

327 
275 

74 

Per  Cent. 

36.2 

30.9 

25.9 

7.0 

Total 


1.060 


100.0 


50 


Table  XXII 

Leprosy  in  Hawaii 

Lepers  by  Race  and  Sex 

MoLOKAi,  June  30,  1918 

Rate  per  100,000  Population 

Males 


Race 

Number 

Rate 

Hawaiian 

210 

1,780.7 

Part  Hawaiian 

64 

795.3 

Korean 

12 

276.8 

Portuguese 

33 

262.3 

Spanish 

2 

162.6 

Chinese 

25 

142.0 

Filipino 

12 

65.4 

Porto  Rican 

2 

65.1 

Other  Caucasian 

5 

26.4 

Japanese 

12 

16.3 

Females 


Number 

Rate 

157 

1,419.9 

57 

707.8 

Total 


377 


222.0 


14 


2 
1 

231 


120.0 


267.6 


Table  XXIII 

Leprosy  in  the  Union  of  South  Africa 

Number  of  Lepers  in  Institutions,  by  Color,  1910  to  1918 

Rates  per  1,000,000  of  Population 


WHITE  — 

COLORED  - 

Year 

Population 

Number 

Rate 

Population 

Number 

Rate 

1910 

1,255,545 

144 

114.69 

4,621,531 

1,678 

363.08 

1911 

1,280,381 

155 

121.06 

4,722,720 

1,782 

377.32 

1912 

1,305,217 

184 

140.97 

4,827,114 

2,042 

423.03 

1913 

1,330,053 

190 

142.85 

4,935,027 

2,054 

416.21 

1914 

1,354,889 

186 

137.28 

5,046,585 

2,006 

397.50 

1915 

1,379,725 

187 

135.53 

5,161,950 

2,080 

402.95 

1916 

1,404,561 

193 

137.41 

5,281,266 

2,088 

395.36 

1917 

1,429,397 

186 

130.12 

5,404,707 

2,146 

397.06 

1918 

1,454,232 

175 

120.34 

5,532,455 

2,055 

371.44 

Data  from  Quarterly  Abstract  of  Union  Statistics,  Number  One,  January,  1920. 
(Office  of  Census  and  Statistics,  Victoria.) 


51 


Table  XXIV 

Leprosy— 

-United  Stat 

States 

Alabama 
Arizona 

0 
0 

1 
0 

s      a 

0 
0 

Arkansas 
California 

0 
39 

0 
0 

0 
23 

Colorado 

3 

0 

3 

Connecticut 

5 

0 

1 

Delaware 

0 

0 

0 

Florida 

Georgia 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

0 
0 
2 
0 
0 
0 
0 

0 
0 
0 
0 
0 
0 
0 

0 
0 
2 
0 
0 
0 
0 

Louisiana 

87 

— 

87 

Maine 
Maryland 

0 
0 

0 
0 

0 
0 

Massachusetts 

Michigan 

Minnesota 

13 

1 

10 

2 

2 
0 

0 

1 
0 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New  Hampshire 

New  Jersey 

New  Mexico 

1                  2 
Information  not 
1                    0 
0                    0 
0                    0 

0  0 
3                   0 

1  0 

available 
1 
0 
0 
0 
3 
1 

New  York 

28t 

0 

7 

North  Carolina 
North  Dakota 

0 
1 

0 
0 

0 
0 

Ohio 


Oklahoma 


1920^ 


Official  (State)  provisions  for  lepers 


Isolation. 

Strict  quarantine — deportation  to 
Island   for   Lepers.    (?) 

Not  stated. 

Leper  colonies  at  San  Francisco, 
Los  Angeles,  local  isolation. 

Quarantine  by  county,  pending 
removal  to  Government  Lepro- 
sarium ! 

State  aid — put  in  isolation  hos- 
pital. 

Quarantined  as  other  communi- 
cable diseases. 

No  provisions  for  lepers. 

Not  stated. 

Isolated  at  county  expense. 

No  provisions  for  lepers. 

Not  stated. 

No  provisions  for  lepers. 

State  Board  of  Health  would  pro- 
vide in  emergency. 

Under  State  control,  isolation, 
(Louisiana  Leper  Home.) 

Not  stated. 

Leper  must  be  cared  for  where 
found. 

Leper  Colony  at  Penikese  Island. 

No  provisions  for  lepers. 

Under  control  of  local  Board  of 
Health,  isolated  in  own  house- 
hold. 

Not  stated. 

Case  isolated  at  county  expense. 

No  provisions  for  lepers. 

No  provisions  for  lepers. 

No  provisions  for  lepers. 

No  provisions  for  lepers. 

None  other  than  modified  isola- 
tion at  home. 

Every  case  investigated  and  diag- 
nosis made.  Isolation.    (?) 

Not  stated. 

Controlled  by  local  Board  of 
Health. 

Isolated  in  home  especially  pre- 
pared on  grounds  of  Dayton 
Quarantine  Hospital. 

Not  stated. 


♦Results  of  special  inquiry  in  co-operation  with  State  and  local  Departments  of  Health. 
tNew  York  City  only. 


52 


Table  XXIV  (Continued) 


States 

Number  of 

known  leperi 

in  State 

January  1, 

1920 

"S 

I 

doubtful, 

additional  oi 

suspected 

cases 

a 

3 

cases 

officially 

segregated 

during  1919 

Official  (State)  provisions  for  lepers 

Oregon 

1 

0 

1 

Isolation. 

Pennsylvania 

6 

0 

— 

Rhode  Island 

0 

0 

0 

No  provisions  for  lepers. 

South  Carolina 

2 

0 

0 

Not  stated. 

South  Dakota 

0 

0 

0 

No  provisions  for  lepers. 

Tennessee 

0 

0 

0 

No  provisions  made. 

Texas 

33 

0 

— 

Not  stated. 

Utah 

0 

0 

0 

None  except  notification  and 
casual  quarantine  or  segrega- 
tion. 

Vermont 

0 

0 

0 

Not  stated. 

Virginia 

1 

0 

1 

Cared  for  by  local  authorities. 

Washington 

1 

0 

1 

Isolated. 

West  Virginia 

0 

0 

0 

No  provisions  for  lepers. 

Wisconsin 

2 

0 

1 

Isolated — and  attendant  provided. 

Wyoming 

0 

0 

0 

Placed  in  pesthouse  same  as  any 
other  contagious  disease. 

Dist.  of  Columbia     0 

0 

0 

Isolation  remote  from  persons  not 

having   disease. 

Total 

242 

7 

134 

Porto  Rico 

37 

— 

— 

There  is  a  law  for  isolation  and 
segregation.* 

*See  footnote  page  17. 


53 


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